Pleasant View Home

In the surveyor’s words

From the most serious findings on record at Pleasant View Home, in the surveyor’s own words.

• Actual harm, isolatedF686Oct 9, 2024

  The facility had a census of 78 residents. The sample included 18 residents, with two reviewed for pressure ulcers (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction). Based on observation, record review, and interview, the facility failed to prevent a facility-acquired deep tissue injury (DTI- purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear) for Resident (R) 15, who sustained a DTI to her left buttock (either of the two round fleshy parts that form the lower rear area of a human trunk) when staff placed a bed pan under R15 backward and left it under her for too long. […]

• No harm, potential for more than minimal, widespreadF812Oct 9, 2024

  The facility had a census of 78 residents and one kitchen. The sample included 18 residents. Based on observation, record review, and interview, the facility failed to store, prepare, distribute, and serve food by professional standards for food service safety. This placed the residents who received their meals from the facility's kitchen at risk for foodborne illness. Findings included: - On 10/08/24 a 10:15 AM, observation in the kitchen revealed the following concerns: 1. Four upper and six lower wooden cupboards located by the three sinks had numerous different-sized scrapes on the outer surface. 2. Three wooden bottom cupboards and nine cupboard drawers located by the ice machine had numerous different-sized scrapes on the outer surface. 3. […]

• No harm, potential for more than minimal, patternF761Oct 9, 2024

  The facility had a census of 78 residents. The sample included 18 residents. Based on observation, interview, and record review the facility failed to identify and dispose of expired medications appropriately. This deficient practice placed residents at risk for ineffective medications. Findings included: - On 10/07/24 at 02:59 PM, observation revealed the Harvest Household medication cart contained the following expired medications: A bottle of calcium supplements with an expiration date of 11/2023. A bottle of senior multivitamins (MVI) with an expiration date of 10/2023. A bottle of MVI with an expiration date of 06/2024. A bottle of magnesium oxide (supplement) with an expiration date of 08/2024. A bottle of D3 (vitamin) with an expiration date of 08/2024. […]

• No harm, potential for more than minimal, patternF880Apr 26, 2023

  The facility had a census of 81 residents. Based on observation, record review and interview the facility failed to adhere to infection control for transmission based precautions (TBP-an infection control intervention designated to reduce transmission of resistant organisms that employs targeted gown and glove used during high contact resident care activities), for Resident (R)7, who had vancomycin resistant enterococci (antibiotic resistant bacterial infections), which placed the residents who received care from the exposed staff at risk for possible exposure of infection. Findings included: - On 04/24/24 at 04:00 PM observation revealed Certified Nurse Aide (CNA) O and CNA P entering the room of R7 who was on TBP. […]

• No harm, potential for more than minimal, patternF657Oct 5, 2021

  The facility had a census of 80 residents. The sample included 19 residents, with eight reviewed for accidents. Based on observation, record review, and interview, the facility failed to revise care plans for five of eight sampled residents, Resident (R) 76, R15, R22, R48, and R23 who had several falls with no new interventions. Findings included: - R76's Physician order [MEDICAL RECORD OR PHYSICIAN ORDER] . The Admission Minimum Data Set, (MDS) dated [DATE], documented the resident had short term memory impairment, wandered daily and was independent with transfers, ambulation, and bed mobility. […]