Every finding on record at Piper Shores

Based on observations and interviews, the facility failed to adequately provide housekeeping services necessary to maintain the building in a sanitary and comfortable environment on 2 of 2 wings (Prout's Neck and [NAME] Beach) for 3 of 3 days of survey.Findings: On 12/8/25 at approx. 11 a.m., on 12/9/25 at approx. 11:30 a.m., and on 12/10/25 at 8:30 a.m., the following was observed:> room [ROOM NUMBER] had bed pan/sitz bath stored on the floor under the sink with a commode bucket lid in the bed pan. > room [ROOM NUMBER] had a bed pan stored on the top of the toilet tank. > room [ROOM NUMBER] had a commode bucket stored on the floor under the sink, in the bucket were 2 bed pans and emesis basin and personal hygiene items stored in the bed pans. > room [ROOM NUMBER] had a commode bucket stored under the sink with a bed pan in it. On 12/10/25 at 9:40 a.m., during an interview, the Director of Nursing stated the storage of bedpans/commode buckets should be in a plastic bag, stored in the closet or in a 3 draw plastic bin but never on the floor without a bag or in something. At this time, both the Director of Nursing and the surveyor observed the rooms above.

Based on observations, record reviews, interviews and the facility policy, the facility failed to maintain a sanitary environment to help prevent the development and transmission of disease and infection related to respiratory care for 2 of 2 residents reviewed for respiratory care (Resident # 12 and #10).Findings 1. On 12/8/25 at 10:17 a.m., observation of Resident #12 receiving oxygen via a nasal cannula with the tubing labeled with a date of 11/28. At this time, Resident #12 stated he/she has oxygen on at all times. The electric wheelchair in his/her room had a travel oxygen pack with an unlabeled nasal cannula tubing wrapped up and hanging off the wheelchair handle. Next to the bedroom door was an oxygen cylinder stored in a caddy with an unlabeled nasal cannula wrapped up and stored hanging off the caddy handle. Resident #12 stated the cylinder is there in case the electricity goes out and the last time he/she used it was about 2 months ago, before I got my oxygen on my wheelchair. Review of Resident #12 medical record lacked evidence of weekly oxygen tubing changes. On 12/8/25 at 2:06 p.m., an additional observation of Resident #12 receiving oxygen via nasal cannula now with the tubing labeled with a date of 12/3-12/10. The oxygen cylinder nasal cannula was now labeled with the date of 12/3-12/10 with the nasal cannula tubing prongs resting on the floor. The wheelchair had an unlabeled nasal cannula tubing that was now wrapped up and halfway out of the oxygen bag pocket. Resident #12 was asked if the oxygen tubing was changed today due to the different date now on the tubing, he/she stated, not this tubing, I have it on my face. I would know if they changed it. On 12/8/25 at 2:13 p.m., the Director of Nursing, Administrator in Training and the surveyor observed the above. Resident #12 again stated the oxygen tubing he/she is wearing had not been changed. He/she was told the tubing is supposed to be changed weekly, he/she stated, they do not change it that frequently. At this time, the surveyor questioned the integrity of the oxygen tubing change and discussed the lack of documentation in Resident #12 medical record for the oxygen tubing change. 2. On 12/8/25 at 11:21 a.m., Resident #10 was observed wearing oxygen via nasal cannula. A nearby oxygen concentrator was set at 2 liters per minute (lpm) and the tubing was dated 11/28. On 12/8/25 at 11:35 a.m., a surveyor discussed with the charge nurse that Resident #10's tubing was dated 11/28, and asked how often staff change the oxygen tubing. The nurse stated I believe it's every week. We'll get it changed out. On 12/9/25, clinical record review revealed a physician order for Resident #10 to receive oxygen at 2 lpm continuously. A review of the treatment administration record noted an entry to change portable oxygen tubing one time weekly on the evening shift. 12/9/25 was signed as the last time the tubing was changed in December. There was no additional documentation for tubing changes in November, 2025. A review of the facility's policy and procedures for Oxygen Concentrator, last revised 1/6/25, Section 5. Care of the Concentrator, c. Nurse Responsibilities, i. Change oxygen tubing and mask/cannula weekly and as needed if it becomes soiled or contaminated. Review of the facility's policy and procedures for Oxygen Administration, last revised 1/6/25, stated in Section 12, Change cannula, mask and tubing every week.

Based on observation, interview, record review and facility policy, the facility failed to ensure products in the walk-in refrigerator and freezer were labeled and/or dated and failed to remove expired foods available for use for 2 of 2 kitchen tours. (12/8/25 and 12/9/25) In addition, the facility failed to ensure the dish machine was maintaining proper temperature ranges for proper washing/rinsing/sanitizing. Findings:1. On 12/8/25 at 9:21 during observation of the [NAME] Kitchen with the Food and Nutritional Director, the walk in refrigerator had a container of cut veggies dated 12/1, a container of cold mayonnaise type salad without a label and dated 12/2, an open and undated package with 2 hot dogs, a container of sliced mushrooms dated 12/4 and container of cooked bacon bits dated 11/24. The Freezer contained an open bag of noodles and open bag of egg rolls. At this time, the Food and Nutritional Director stated the container dates are when the left overs were put into the refrigerator and these products have a 3 day time limit and confirmed the out of date, unlabeled and/or open food products.2. On 12/9/25 at 2:27 p.m., an additional observation of the [NAME] Kitchen with the Certified Food Manager, the walk-in refrigerator had the container of cooked bacon bits dated 11/24, the container of cold mayonnaise salad with no label dated 12/2 and the container of cut up veggies dated 12/1 were still available for use. At this time, the Certified Food Manager confirmed the above containers of food should have been discarded within 3 days. The facilities Storage and use of leftover food policy and procedure dated 9/5/25 states under #2. Storage of Leftovers. Foods must be covered, wrapped, or placed in sealed, food-safe containers. 3. Labeling and Dating, all leftover items must be labeled with: Name of the food item, Date and time of preparation or service, use-by/discard date and Refrigerated leftovers must be used within 3 days unless frozen leftovers must be used within 30 days.3. Review of the October, November and December 2025 High temp dishwasher Final rinse temperature logs revealed the following temperatures for Breakfast, Lunch and Dinner. The logs lacked evidence of the facility monitoring the wash cycles for the minimum temperature requirements. * [NAME] Kitchen wash/rinse temp log October 2025 has documented temperatures for Breakfast final rinse temp where the temperature was below 180 degrees 11 out of 31 days, Lunch had 3 out of 31 days.* [NAME] Kitchen wash/rinse temp log November has documented temperatures for Breakfast final rinse temp where the temperature was below 180 degrees 23 out of 30 days, Lunch had 2 out of 30 days and dinner 1 out of 30 days.* [NAME] Kitchen wash/rinse temp log December has documented temperatures for Breakfast final rinse temp where the temperature was below 180 degrees 4 out of 8 days reviewed.* Health Center Kitchen wash/rinse temp log October has documented temperatures for Breakfast final rinse temp where the temperature was below 180 degrees 2 out of 31 days, Lunch had 6 out of 31 days and dinner 1 out of 31 days.* Health Center Kitchen wash/rinse temp log November has documented temperatures for Breakfast final rinse temp where the temperature was below 180 degrees 4 out of 30 days, Lunch has 6 out of 30 days and dinner 4 out of 30 days.* Health Center Kitchen wash/rinse temp log December has documented temperatures for Breakfast final rinse temp where the temperature was below 180 degrees 1 out of 8 days reviewed and lunch had 3 out of 7 days reviewed. On 12/9/25 at approx. 3:00 p.m., the above, out of range temperatures and the lack of monitoring of the wash cycle temperatures were discussed with the Food and Nutritional Director and the Certified Food Manager. At this time, the Food and Nutritional Director stated that in his years of being in food service he has never documented the wash cycle temperatures. The facilities Dishwasher Temperature back-up system policy and guidelines, revised 9/2/25 states under Guidelines, All cooking and service utensils, including glassware will be washed in the appropriate kitchen with a logged final rinse cycle of 180 F or higher. Wash cycles will be a minimum of 160 F.

Based on observation and interview, the facility failed to adequately date and properly dispose of open medications according to manufacturer specifications for 1 of 1 medication rooms observed.On 12/9/25 at 10:06 a.m. during an observation of the medication room with Registered Nurse (RN) #1, a surveyor observed an opened 30 milliliter, multi-dose, bottle of Lorazepam Intensol Oral Concentrate 2 milligram per milliliter with no open date, and with manufacturer recommendations to discard open bottle after 90 days. The RN then placed the bottle back into the refrigerator for use.On 12/9/25 at 11:35 a.m. during an interview, RN #1 stated they had pulled the undated medication from the refrigerator and then presented the controlled substance log to the surveyor that stated the bottle was opened on 8/6/25.On 12/9/25 at 11:37 a.m. the above findings were confirmed with RN #1.

Based on record review and interview, the facility failed to ensure the resident record was complete and accurately reflected Certified Nursing Assistant (CNA) provided care for 1 of 1 resident reviewed. (Resident #11) Review of CNA Activities of Daily Living (ADL) documentation for Resident #11 for the months of November and December 2025 revealed missing documentation for scheduled daily activities including toileting, transfers and locomotion. Missing documentation was identified on 16 out of 30 days in November and 4 out of 9 days in December 2025.The CNA's task list indicated these cares were required daily; however, documentation was not completed consistently in the resident records.On 12/15/25 at 10:34 a.m. the above finding was discussed with the Director of Nursing

Based on interviews, record reviews and facility policy, the facility failed to ensure all facility staff maintain training in cardiopulmonary resuscitation (CPR) for Healthcare Providers. Findings: On [DATE] at 10:11 a.m., the Staff Development Coordinator stated the facility does not track or ensure their staff including the Licensed Nurses and Certified Nursing Assistants (CNA's) have an active CPR certification and that CPR is not a requirement. On [DATE] at 10:11 a.m., the facility provided documentation of current CPR certifications for 10 of 17 Registered Nurses (RNs), 2 of 7 Licensed Practical Nurses (LPNs), 9 of 44 CNAs, 1 of 2 Personal Support Staff (PSS), 1 of 3 Activity staff, and 0 of 2 administrative personnel. On [DATE] at 10:53 a.m., during an interview, the DON, stated he himself was not CPR certified and hasn't been since he is not working the floor. In addition, he confirmed there is 1 of the 36 residents who is Full Code and could potentially require CPR however, all residents are at risk for choking. Facility Policy's and Procedure and Job Descriptions: Policy for Cardiopulmonary Resuscitation (CPR), revised on [DATE], under Policy Explanation and Compliance Guidelines States, Staff will maintain current CPR certification for health care providers through a CPR provider who evaluates proper technique through in person demonstration of skills. CPR certification which includes an online knowledge component yet still requires in person skills demonstrations to obtain certification or recertification is also acceptable. The facilities Job Description for a Charge Nurse, dated ,d+[DATE], under qualifications: states, Current CPR certification/IV certification desired. On [DATE], at approximately 11:00 a.m. the above information was confirmed with the Director of Nursing and the Staff Development Coordinator.

Based on observation and interviews, the facility failed to ensure that expired over the counter medications were removed from the supply that were available for use in 1 of 1 medication storage room and failed to ensure the medication room refrigerator was maintained at an acceptable temperature range for 15 of 39 days. In addition, the facility failed to ensure medications were stored properly by having an unlocked, unattended medication cart allowing residents and unauthorized persons access to medications on 1 of 3 survey days. Findings: 1. On [DATE] at 1:50 p.m., during a medication supply cabinet review with the Registered Nurse (RN #1), and a surveyor observed the following expired over the counter medications: 2 unopened bottles of Healthstar Aspirin 325 milligrams (mg) with an expiration date of ,d+[DATE], 4 unopened bottles of Gericare Aspirin 325 mg with an expiration date of ,d+[DATE] and 2 unopened bottles of Gericare Multivitamin with an expiration date of ,d+[DATE]. 2. On [DATE] at 2:00 p.m., a surveyor and RN #1 observed the medication storage room refrigerator on the [NAME] unit. The refrigerator contained insulin, immunizations and controlled liquid medications. A temperature log sheet, located on the counter above the refrigerator dated for the month of August and [DATE], states, Acceptable temperature range 36 - 46 degrees Fahrenheit and The temperature of each medication refrigerator must be checked daily and recorded on this log. If an out-of-range temperature is found, notify Clinical Engineering and document your response. A review of the temperature log sheet had multiple days when temperatures were documented below 36 degrees Fahrenheit and lacked evidence of documentation of action taken to correct the low temperatures. The refrigerator temperatures were as follows: On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 34 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 34 degrees Fahrenheit On [DATE] documentation of 34 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 34 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] documentation of 34 degrees Fahrenheit On [DATE] documentation of 34 degrees Fahrenheit On [DATE] documentation of 35 degrees Fahrenheit On [DATE] at 2:10 p.m., a surveyor confirmed the above findings with the Director of Nursing. 3. On [DATE] at 9:28 a.m., a surveyor observed the medication cart in the hallway outside resident room [ROOM NUMBER]. The cart was unlocked and there was no staff member near the cart. A surveyor opened 2 drawers of the medication cart and observed over the counter and prescription medications labeled for residents. At 9:35 a.m., (7 minutes later) the Certified Nursing Assistant - Med Tech (CNA-M) returned to the medication cart. During an interview with a surveyor. The CNA-M acknowledged that the medication cart should have been locked. On [DATE] at 10:00 a.m., a surveyor discussed the finding of the unlocked, unattended medication cart with the Director of Nursing.

Based on record review and interview, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) Form 10055, which included appeal rights and liability of payment, were provided at least 2 days prior to the resident's last covered day, for 2 of 3 residents whose Medicare Part A services were discontinued, and remained in the facility (#13, #21). Findings: 1. Resident #13 who remained in the facility, had a SNFABN which indicated he/she's last day of Skilled services was on 9/8/24. Resident #13 was not provided the SNFABN until 9/9/24, the day after services ended. 2. Resident #21 who remained in the facility, had a SNFABN which indicated he/she's last day of Skilled services was on 7/1/24. Resident #21 was not provided the SNFABN until 7/2/24, the day after services ended On 9/9/24 at 1:07 p.m., in an interview with the surveyor, the Social Worker stated she was unaware that the SNFABN notices should be provided to resident and/or resident representative 48 hours prior to services being terminated.

Based on observation and interview the facility failed to provide maintenance services necessary to maintain a sanitary and comfortable interior on 2 of 2 units observed (Prouts Neck Walkway and [NAME] Beach Walkway). Findings: On 9/11/24 from 10:02 a.m., during a tour of the facility, the Director of Nursing confirmed the following: 1. Prouts Neck Walkway in the Personal Care room, the exhaust fan was coated with dust, the shower room had orange/brown color-stained tiles from the shower rail to the floor and the base of the shower had what appeared to be white tape with the corners lifting up and areas of discolored black and orange colors. 2. [NAME] Beach Walkway in the Personal Care room, the exhaust fan was coated with dust.

Based on observation, interview, and record review, the facility failed to be free of medication error rate of 5% or more. There was a total of 2 medication errors out of 29 opportunities. The medication error rate was 6.9%. Finding: On 9/11/24 at approximately 8:47 a.m., a surveyor observed the Certified Nursing Assistant (CNA-M) prepare medications for Resident #9, which included physician orders for: Senna Plus (senna 8.6 mg (milligrams) with ducosate sodium 50 mg) Give 1 tablet by mouth twice a day for constipation and Aspirin 81 mg tablet, delayed release, give 1 tablet by mouth every day for heart health. The CNA-M dispensed one tablet of the Senna 8.6 mg and Aspirin 81 mg chewable into the medicine cup. At this time the surveyor intervened, questioning the dosage of tablets dispensed of both the Senna and Aspirin. The CNA-M reviewed the medications in the medicine cup and confirmed she did not dispense the correct medications of Senna Plus and the delayed release Aspirin. On 9/11/24 at approximately 9:45 a.m., the above findings were discussed with the Director of Nursing.

Based on observations and interviews, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner relating to the ceiling air intakes vents and the over-the-stove exhaust hood in the main kitchen on the third floor. Findings: On 9/9/24 at 8:40a.m., during the initial kitchen observation, a surveyor noted the two main air intake vents were covered with a moderate to heavy amount of dirt and debris. In addition, one-half of the over the stove exhaust hood was covered with a heavy amount of a grease like substance. At this time, the above was confirmed with the Food and Nutrition Director.

Based on Certified Nursing Assistant (CNA) employee education record review, the facility failed to monitor and ensure that the CNA attended the required 12 hours of annual in-service education training and the mandatory yearly training for dementia care 2 of 5 randomly selected CNAs employed greater than 1 year (CNA #3 and CNA #4). Findings: On 9/10/2024 and 9/11/2024, a surveyor reviewed the following employee education files: 1. CNA #3 was hired 5/7/2021. Review of CNA #3 Employee In-service/attendance 2ecords stated, she has 1 of the 12 hours required for continuing education and lacked evidence of dementia training for the year of 2023. 2. CNA #4 was hired 6/19/2017. Review of CNA #4 Employee In-service/attendance records stated, she has 2.25 of the 12 hours required for continuing education and lacked evidence of dementia training for the year 2023. On 9/11/2024 at 11:40 a.m., the above information was confirmed with the Director of Human Resources.

Based on record review and interview, the facility failed to transmit a quarterly Minimum Data Set (MDS) electronically to the State MDS database within 14 days of completion date for 1 of 2 system selected residents reviewed for Resident Assessment (Resident #31). Finding: Resident #31's quarterly MDS was completed on 7/15/24. This assessment was required to be electronically submitted to the State MDS database within 14 days after completion, as of 9/10/24 the MDS had not submitted to the State MDS database. On 9/10/24 at 12:04 p.m., during an interview, the MDS Coordinator stated that she will submit Resident #31's quarterly MDS today and was unaware that it wasn't transferred until the surveyor asked about it.

Based on record review and interview, the facility failed to ensure its water management program was implemented and effective to prevent the growth of Legionella or other waterborne pathogens. This has the potential to affect all residents. Additionally, the facility failed to ensure proper hand hygiene post perineal care for 1 of 1 resident observed during care. (# 17). Finding: 1. A review of the facility's water management policies and procedures, Control Locations Management Log, stated Microbial sampling to validate the water management program, with specific testing for Legionella, to be completed at a minimum frequency of quarterly. A review of laboratory reports from the facility's contracted water management company indicated the last testing for Legionella bacteria was completed on 9/15/21. On 7/11/23 at 2:00 p.m., in an interview with the surveyor, the Administrator, the Manager of Plant Operations, and the Director of Plant Operations, Maintenance and Security, confirmed that testing to monitor the effectiveness of the water management program had not been completed since 2021, which was not in compliance with company policy. 48648 2. On 7/11/2023 at 12:01 pm a surveyor observed both CNA#5 and CNA#1 assist resident #17 providing perineal care while wearing gloves. They did not perform hand hygiene or remove the gloves before they helped resident #17; finish dressing, arrange items on the table, smooth the hair, make the bed, and tidy up the room. On 7/11/2023 at 12:15 pm a surveyor interviewed CNA#5 and asked when hand hygiene should be performed. CNA#5 said after pericare and realized after she said this that she did not do this while being observed. On 7/11/2023 at 12:25 pm a surveyor interviewed CNA#1 and asked when hand hygiene should be performed. CNA#1 also stated after pericare and also realized she did not do this while being observed. On 7/11/2023 at 3:46 pm, the above was confirmed with Clinical Assessment Manager.

Based on observations and interviews, the facility failed to ensure resident's dignity by requiring a resident wear a clothing protector after stating that she/he does not want to wear one on 1 of 4 observations in the dining room. (#19). Findings: On 7/11/2023 at 8:10 a.m. in the dining room, a surveyor observed Resident #19 being wheeled into place at a table by a staff member and placed a clothing protector on the resident. Resident #19 stated No, I don't want to wear this. Staff member said, Oh you have to wear this, you would not want to get your sweater all dirty. On 7/11/23 the dignity issue was confirmed by the surveyor at the time of the observation the with the Infection Preventionist and at 5:00 p.m., the dignity issue was discussed with the Administrator.

Based on observations and interviews, the facility failed to ensure that a call bell was accessible to 1 of 40 sampled residents observed for 1 of 3 days of survey (Resident #22). Findings: On 7/10/2023 at approximately 11:30a.m. a surveyor observed Resident #22 sitting in her/his wheel chair with the brakes on, approximately 6 feet away from her/his bed and the call bell was lying on the resident's bed. Resident is not able to move wheel chair on her own. This was called to the attention of and confirmed with CNA#1 and reported to RN#1. and confirmed with the Administrator at 12:15p.m.

Based on observations, interviews and record review the facility failed to ensure that a residents careplan was implemented, for 1 of 1 sampled resident reviewed for suicidal ideation ( #39). Findings; On 7/11/2023 a surveyor reviewed resident #39's care plan and noted: Category: 9 Behavior Problem lists Do not leave a gait belt in [Resident #39s] room. On 7/11/2023 at 12:17 pm a surveyor observed CNA#3 exit Resident #39s private bathroom with a gait belt. On 7/11/2023 at 12:40 pm a surveyor interviewed CNA#3 who confirmed that the gait belt was retrieved from resident's bathroom. CNA #3 confirmed that the gait belt is normally found in resident's room and they were unaware of the care plan stating gait belt was not be left in the room. On 7/11/2023 at 12:46 pm a surveyor interviewed CNA#1 and CNA#4 together and both confirmed the gait belt was normally stored in resident's room. They were both unaware it was in the care plan to remove this item from the room after use. On 7/11/2023 at approximately 4:00 pm, an interview was conducted with Resident #39, he/she was able to confirm that the gait belt is left in his/her room, and was able to point out the places that staff leave it. On 7/11/2023 at 3:45 pm a surveyor confirmed with Clinical Assessment Manager that the identified items in Resident #39's care plan was not removed per their policy and resident #39's care plan.

Based on record reviews and interviews, the facility failed to follow up on a pharmacist recommendation timely, and failed to keep all copies of Medication Regimen Reviews (MRR) in the resident's permanent health record for 1 of 5 residents reviewed for medications (Resident #24). Finding: On 7/11/23, Resident #24's clinical record was reviewed. On 7/11/23 at 3:07 p.m. a surveyor requested from the Clinical Assessment Manager (CAM), the Consultant Pharmacist's (CP) MRR recommendations completed in May of 2023 as it was not able to be located in the resident's permanent record. On 7/12/23 at 10:27 a.m., the CAM provided a surveyor with the CP MRR recommendation completed by the CP on 5/3/23. Between 5/1/23 and 5/3/23, the CP completed a Consultant Report comment that indicated, continues to be at moderate or high risk of falls. Continues with foley [a flexible tube that drains urine from the bladder] - which is now chronic? Still on tamsulosin [a medication to help with urinary retention] with recommendation that indicated, Please consider dc (discontinuing) the tamsulosin if plan is to keep foley long term. This resident has been taking, as ordered by the Medical Provider, tamsulosin 0.4 milligrams by mouth every evening for a diagnosis of BPH with urinary obstruction [benign prostatic hyperplasia, or enlarged prostate, with urinary retention]. The clinical record lacked evidence that this recommendation was addressed by the Medical Provider as of 7/12/23. On 7/12/23 at 10:27 a.m., during an interview with the CAM, a surveyor confirmed this finding. The CAM stated she doesn't recall seeing the recommendation from the CP. On 7/12/23 the CAM stated she printed the original CP's MRR recommendation; however, the recommendation was not addressed by the Medical Provider, or could not be located at the facility or in the resident's permanent record.

Based on record review and interview, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) Form 10055, which included appeal rights and liability of payment, were provided at least 2 days prior to the resident's last covered day, for 3 of 3 residents whose Medicare Part A services were discontinued, and remained in the facility (#39, #201, #202). Findings: 1. Resident #39's Medicare Part A coverage for skilled services ended on 7/5/2023. The medical record lacked evidence that Resident #39 or his/her legal representative was provided a SNFABN when the Medicare A coverage for skilled services was discontinued. The resident remained living in the facility. 2. Resident #201's Medicare Part A coverage for skilled services ended on 4/21/2023. The medical record lacked evidence that Resident #201 or his/her legal representative was provided a SNFABN when the Medicare A coverage for skilled services was discontinued. The resident remained living in the facility. 3. Resident #202's Medicare Part A coverage for skilled services ended on 5/15/2023. The medical record lacked evidence that Resident #202 or his/her legal representative was provided a SNFABN when the Medicare A coverage for skilled services was discontinued. The resident remained living in the facility. On 7/12/2023 at 12:00 p.m., in an interview with a surveyor, the Licensed Clinical Social Worker confirmed that the facility did not deliver a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) when Medicare Part A coverage for skilled services ended and the residents remained in the facility.

Based on interview and record review, the facility failed to issue a written transfer/discharge notice, which included information regarding appeal rights and the name and address of the Office of the State Long-Term Care Ombudsman, to residents or their representative for 1 of 1 sampled residents transferred/discharged by the facility to an acute care hospital (Resident #11). Finding: On review of the clinical record, the surveyor noted Resident #11 was transferred to an acute care facility on 5/2/2023 for evaluation and treatment of complications associated with an indwelling urinary catheter, and again on 6/10/2023, for evaluation and treatment of altered mental status and abdominal pain. The clinical record lacked evidence that the facility had provided a transfer/discharge notice to the resident and his/her representative. On 7/12/2023 at 3:20 p.m., in an interview with a surveyor, the facility's Director of Nursing, Clinical Assessment Manager, and Licensed Clinical Social Worker confirmed transfer/discharge notices are not provided to residents and their representatives, upon transfer to an acute care facility. In addition, it was confirmed that the facility is not providing notice of resident transfers/discharges to the Office of the State Long-Term Care Ombudsman.