Plaza Healthcare

In the surveyor’s words

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

• No harm, potential for more than minimal, patternF842Jan 24, 2025

  Based on clinical record review, staff interviews, and facility policy review, the facility failed to maintain medical records that are complete and accurate in accordance with professional standards for 4 of 26 sampled residents (# 9, 240, 241, 236). The deficient practice could result in records that do not accurately and completely reflect the care and services provided to residents. Findings include: -Regarding Resident #236 Resident #236 was admitted on [DATE] with diagnoses that included chronic respiratory failure with hypoxia, tracheostomy, morbid obesity, anxiety disorder, psychotic disorder with delusions, and type 2 diabetes with retinopathy of the right eye. […]

• No harm, potential for more than minimal, patternF812Jun 16, 2022

  Based on observations, staff interviews, and policy review, the facility failed to ensure staff members wore hair restraints appropriately, kitchenware was clean, and that fans were clean. The deficient practice could increase the risk of foodborne illness. Findings include: Regarding hair restraints During the initial kitchen observation conducted on June 13, 2022 at 11:07 a.m., a staff member working in the food line was observed wearing hair restraints that did not have all of her hair restrained. She had her hair up in a French twist-bun fashion with only half of the back of her head covered by the hairnet, while the rest of her hair was exposed, and loose hair was hanging down. A second observation was conducted on June 15, 2022 at approximately 10:50 a.m. […]

• No harm, potential for more than minimal, patternF880Jun 16, 2022

  Based on observations, staff interviews, and policy review, the facility failed to ensure staff followed infection control standards related to wearing PPE (personal protective equipment). The deficient practice could result in transmission of infection including COVID-19. Findings include: An observation was conducted on June 13, 2022 at 11:07 am in the facility kitchen. Staff #178 (dishwasher) and staff #203 (cook) were observed with N95 face masks that were improperly worn. Both staff members had their masks lowered and their noses were exposed. Another observation was conducted on June 15, 2022 at 10:50 am. […]

• No harm, potential for more than minimal, isolatedF658May 8, 2026

  Based on observation, interviews, and review of facility policy and procedure, the facility failed to ensure that professional standards of practice and facility policies were followed for administration of medications via gastrointestinal tube. The deficient practice could cause the resident to aspirate, cause infection, and medications being administered to the wrong resident.Findings include:A medication administration observation was conducted with Licensed Practical Nurse (LPN/staff #142) on May 7, 2026 at 8:28 A.M. The LPN was observed carrying a tray with a clear cup of medications crushed in water and also a cup of water. When entering the resident's room the LPN introduced herself, but was not observed to identify the resident by the wrist band prior to medication administration. […]

• No harm, potential for more than minimal, isolatedF761May 8, 2026

  Based on observation, interviews, and review of facility policy and procedure, the facility failed to ensure that expired medication were not available for use. The deficient practice could lead to residents receiving medications that are expired.Findings include:An observation was conducted on May 7, 2026 at 9:38 A.M. with Licensed Practical Nurse (staff #142). The observation of the medication cart revealed eight medications loose at the bottom of the medication cart under the resident medication cards. At this time the Resident Nurse Unit Manager (staff #16) removed the medications from the cart and placed them in a medication cup.Immediately after the observation an interview was conducted on May 7, 2026 at 9:40 A.M. […]