Pine Village

In the surveyor’s words

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

• Immediate jeopardy, isolatedF609Oct 26, 2021

  The facility had a census of 70 residents. The sample included one resident reviewed for abuse. Based on observation, record review, and interview, the facility failed to ensure staff identified an injury of unknown origin as an alleged violation potentially involving abuse, neglect or mistreatment. The facility further failed to ensure staff immediately reported the alleged violation (injury of unknown origin) to the facility administrator. On 10/12/21, Certified Medication Aide (CMA) R and Licensed Nurse (G) identified significant bruising to Resident (R) 1's inner thighs. Both staff failed to identify R1's injury as possible abuse and report to Administrative Staff A. […]

• No harm, potential for more than minimal, widespreadF812May 6, 2025

  The facility had a census of 66 residents. The sample included 17 residents. Based on observation, record review, and interview, the facility failed to store food by professional standards for food service safety in one kitchen. This deficient practice placed the residents who received their meals from the facility's kitchens at risk for foodborne illness. Findings included: - On 05/04/25 at 08:34 AM, the silver upright freezer, located by the entrance door, inside the kitchen, had the following: A cardboard box had the plastic torn open, exposing four corn dogs. A cardboard box had the plastic torn open, exposing 19 (4-ounce (oz) beef burger patties. A cardboard box had the plastic torn open, exposing 16 (2.6oz) chicken patties. […]

• No harm, potential for more than minimal, widespreadF851May 6, 2025

  The facility had a census of 66 residents. Based on observation, record review, and interview, the facility failed to submit complete and accurate staffing information through Payroll-Based Journal (PBJ) as required. This deficient practice placed the residents at risk for unidentified and ongoing inadequate nurse staffing. Findings included: - The PBJ report provided by the Centers for Medicare and Medicaid Services (CMS) for Fiscal Year (FY) 2024 Quarter (Q) 1 indicated no Registered nurse (RN) hours for four days in October 2024 and two days in November 2024. A review of the facility's staffing and RN hours of the days listed above revealed RN coverage. On 05/06/25 at 09:18 AM, Administrative Staff B stated that Q1 was the first time she'd submitted the information by herself. […]

• No harm, potential for more than minimal, widespreadF730Aug 31, 2023

  The facility had a census of 72 residents. The sample included 18 residents. Based on record review and interview, the facility failed to complete performance reviews of all nurse aides, provide regular in-service education based on the outcome of these reviews, and ensure all nurse aides received the required number of in-service training hours per year. This placed the residents at risk for inadequate care. Findings included: - The facility's employment records documented the nurse aides who were employed at the facility for at least one year, review of the facility's in-service records documented one of the five Certified Nurse Aide (CNA) M lacked the required 12 hours of in-service training in the past year. […]

• No harm, potential for more than minimal, patternF880May 6, 2025

  The facility had a census of 65 residents. The sample included 13 residents. Based on observation, record review, and interview, the facility failed to use appropriate barriers while sorting soiled laundry. This placed the residents at risk of infectious diseases. Findings included: - On 05/06/25 at 07:47 AM, while on tour of the laundry department, Maintenance/Housekeeping Staff U stated the soiled laundry was sorted by laundry staff using only gloves; unless there was obvious visual soilage, and then a gown would be worn. […]