Every finding on record at Pruitthealth - The Lodge, LLC

Based on observations, staff interviews, and review of the facility policy titled Food Preparation and Service, the facility failed to discard food by the expiration date, label and date leftovers, and store dishwasher crates off of the floor. These deficient practices had the potential to promote foodborne illnesses associated with bacterial growth and cross-contamination for 67 of 73 residents receiving an oral diet. Findings include: Review of the facility's undated policy titled Food Preparation and Service revealed, Food service employees shall prepare and serve food in a manner that complies with safe food handling practices. The Leftover Food section included . 4. Leftover food must be covered, labeled, and dated. 5. Leftover food must be used within 7 days (refrigerated) or 30 days (frozen). 9. Disposal-Expired or unsafe food must be thrown away. During a tour of the kitchen on [DATE], beginning at 7:53 am with the Assistant Dietary Manager (ADM), the following concerns were identified: One 5.5-ounce container of leaf basil with an expiration date of [DATE]. One 5.5-ounce container of jerk seasoning with an expiration date of [DATE]. One 16-ounce container of ground nutmeg with an expiration date of 2023. One 16-ounce container of seasoning with an expiration date of [DATE]. One 26-ounce container of fajita seasoning with an expiration date of [DATE]. One 12-ounce container of ground oregano with an expiration date of [DATE]. Observations in the walk-in cooler revealed the following: One container of ham with an open date of [DATE]. One container of strained broccoli soup with an open date of [DATE]. One bag of biscuits with an open date of [DATE]. One container of leftovers, identified by the ADM as baked ziti, with a date of [DATE]. Observations in the main kitchen dry pantry storage room revealed three boxes of oatmeal cream pies with an expiration date of [DATE]. Observation in the kitchen revealed four dish crates were stored on the floor. Observation of the 400 Hall Resident Pantry revealed three boxes of oatmeal cream pies with an expiration date of [DATE]. Observation of the refrigerator revealed one container of milk with an open date of [DATE] and an expiration date of [DATE] and a container of unidentified, unlabeled leftovers. Observation of the 200 Hall Resident Pantry revealed two boxes of oatmeal cream pies with an expiration date of [DATE]. In an interview on [DATE] at 8:30 am, the ADM confirmed all findings. She confirmed that the dish storage crates should not be on the floor but on a rack. In a concurrent interview and observation on [DATE] at 8:30 am, the Dietary Manager (DM) confirmed that the four dish storage crates lying on the floor underneath a food prep table should not be stored on the floor. The DM stated food items should be dated when opened and expire seven days from that date. He further stated the ADM had informed him of the findings and that he was unaware of the identified concerns before being informed. He stated that dietary staff was responsible for daily monitoring of the dry pantry, cooler, freezer in the main kitchen, and resident pantries. He stated his expectations were for dietary staff to follow policy and ensure items were labeled, dated, and discarded by the expiration date. He further stated there was a potential for resident illness if staff did not follow the policies.

Based on observations, staff interviews, record review, and review of the facility policies titled Cleaning and Disinfection of Resident-Care Items and Equipment, Personal Protective Equipment (PPE), and Administration of IV (intravenous) Medications, the facility failed to properly cover resident personal care items when not in use on two of four halls (Hall 200 and Hall 300) and ensure infection control processes were followed during medication administration for three of five residents (R) (R183, R187, and R188) observed for medication administration. The deficient practices had the potential to place R183, R187, and R188 at risk of avoidable spread of infections and had the potential to increase the risks for cross-contamination and spread of infection on two of four halls. Findings include: Review of the facility policy titled Cleaning and Disinfection of Resident -Care Items and Equipment, revised August 2009, revealed the Policy Statement stated, Resident care equipment, including reusable items and durable medical equipment, will be cleaned and disinfected according to current CDC (Centers for Disease Control and Prevention) recommendations for disinfection and the OSHA (Occupational Safety and Health Administration) Bloodborne Pathogens Standard. The Policy Interpretation and Implementation sections included 1. c. Non-critical items are those that come in contact with intact skin but not mucus membranes. (1) Non-critical resident-care items include bedpans, blood pressure cuffs, crutches, and computers. (2) Most non-critical reusable items can be decontaminated where they are used (as opposed to being transported to a central processing location). Review of the facility policy titled Personal Protective Equipment, dated 1/17/2017, revealed the Purpose section stated, The purpose of this procedure is to appropriately don and doff (put on and take off) personal protective equipment. The Guidelines Section stated, The facility follows CDC sequencing PPE for safe work practices to protect yourself and limit the spread of contamination. The How to Safely Remove PPE guidelines included removing all PPE before exiting the patient room except a respirator if worn. Review of the facility's undated policy titled Administration of IV Medications revealed the Purpose section stated, The purpose of this procedure is to provide guidelines for IV medication administration. The Infusion section included . 6. Vigorously wipe the hub of the needleless connector on the IV device with an antiseptic swab for 5 - 15 seconds and allow it to dry. 7. Attach a prefilled saline syringe, check for blood return, then flush to check patency. Detach the syringe and discard. 8. Vigorously wipe the hub of the needleless connector on the IV device with an antiseptic swab for 5 - 15 seconds and allow it to dry. 1. Observation on 2/14/2025 at 9:45 am revealed an unbagged and unlabeled urinal in the bathroom sink of resident room [ROOM NUMBER]. Observation on 2/14/2025 at 9:55 am revealed an unbagged and unlabeled bath basin on the floor in the bathroom of resident room [ROOM NUMBER]. Observation on 02/14/2025 at 10:17 am revealed an unbagged and unlabeled bath basin on the floor in the bathroom of resident room [ROOM NUMBER]. Observation on 2/14/2025 at 12:04 pm revealed an unbagged and unlabeled bath basin on the floor in the bathroom of resident room [ROOM NUMBER]. In an interview on 2/14/2025 at 12:31 pm, Certified Nurse Assistant (CNA) CC stated urinals should not be in the sink and should be bagged and labeled. In a concurrent observation and interview on 2/14/2025 at 12:43 pm, Unit Manager (UM)/Licensed Practical Nurse (LPN) AA verified that the bath basins in the bathrooms of resident rooms [ROOM NUMBER] were not bagged or labeled. She stated that personal care items should be labeled, bagged, and stored off the floor. In an interview on 2/16/2024 at 11:15 am, the Director of Nursing (DON) stated it was her expectation for personal care items to be bagged separately, labeled, off of the floor and that urinals should never be left in a sink. 2. During observation of a medication pass on 2/15/2025 at 8:35 am, LPN BB was observed taking R183's blood pressure using an electronic blood pressure machine. She did not disinfect the blood pressure cuff before or after taking the resident's blood pressure. Continued observation revealed LPN BB used the same blood pressure cuff to check R187's blood pressure. She did not disinfect the blood pressure cuff before or after checking the resident's blood pressure. In an interview on 2/15/2025 at 9:20 am, LPN BB verified she did not disinfect the blood pressure cuff between residents and stated she should disinfect it between each resident. In an interview on 2/15/2025 at 12:43 pm, UM/LPN AA stated the blood pressure cuffs should be disinfected between each resident use. In an interview on 2/16/2025 at 11:15 am, the DON stated it was ideal for the electronic blood pressure cuffs to be cleaned between each resident. 3. During observation of a medication pass on 2/15/2025 at 9:03 am, LPN BB was observed administering medication to R187, and observation revealed R187 was on Enhanced Barrier Precautions (EBP). LPN BB was observed putting on PPE before entering the room, administering the medication, exiting the room, removing the PPE in the hallway, and discarding it in the trash can on the medication cart. In an interview on 2/15/2025 at 9:20 am, LPN BB stated she removed the PPE in the hallway because she couldn't find a trash can in the resident's room. In an interview on 2/15/2025 at 12:43 pm, UM/LPN AA stated that PPE should be removed in the resident's room before exit and not in the hallway. In an interview on 2/16/2025 at 11:15 am, the DON stated the expectation was for PPE to be removed in the resident rooms, not in the hallways. 4. During observation of a medication pass on 2/15/2025 at 12:20 pm, LPN BB was observed administering an IV medication to R188. Observation revealed LPN BB wiped the hub of the needleless connector on the peripherally inserted central catheter (PICC) [a flexible tube inserted in the upper arm and threaded into a large vein above the heart] with an alcohol wipe for two to three seconds before administering the saline flush and again before administering the medication. In an interview on 2/15/2025 at 12:48 pm, LPN BB confirmed she wiped the hub of the needleless connector on the PICC line with an alcohol wipe for two to three seconds and stated she should have wiped it for five to 15 seconds. In an interview on 2/15/2025 at 4:15 pm, UM/LPN AA confirmed the PICC line needleless hubs should be cleaned with an antiseptic wipe for five to 15 seconds before each use and stated two to three seconds was not long enough. In an interview on 2/16/2025 at 11:58 am. The DON stated her expectation was for the PICC line needleless hub to be cleaned with alcohol vigorously for five to 15 seconds before administering saline flush and medications via the PICC line.

Based on staff interview, record review, and review of the facility's policy titled Abuse Policy and Procedure, the facility failed to report an injury of unknown origin, specifically left acute distal tibial and fibular fractures, within the required time frame for one of three sampled residents (R) (R3). Findings include: Review of the facility's policy titled Abuse Policy and Procedure, with a revision date of 2020, revealed all allegations of abuse involving abuse along with injuries of unknown origin are reported immediately to the charge nurse and/or administrator of the facility along with other officials in accordance with State law through established guidelines. The Investigation section of the policy documented all allegations of abuse will be investigated and reported to the appropriate agencies. Review of the Nurse's Notes for R3, dated 6/13/2024, revealed physical therapy reported the resident had pain and was unable to bear any weight. The physician was notified and ordered an x-ray of the left ankle. The Radiology Results Report, dated 6/14/2024, documented the left ankle noted acute distal tibial and fibular diaphyseal fractures. The Orthopedic Progress Notes, dated 6/20/2024, documented the resident had a new fracture of her tibial fibula. Review of the Facility Incident Report Form revealed the State Survey Agency was not notified of the injury of unknown origin and fractures until 6/21/2024. The report also documented the incident occurred on 6/20/2024, although the radiology results on 6/14/2024 were positive for fractures. During an interview with the Administrator on 10/24/2024 at 12:20 pm, she stated there was a delay in the reporting of the fracture from the 6/14/2024 x-ray report because they wanted to get the results from the orthopedic physician to make sure it was a new fracture since the resident had been having ongoing problems with a nonhealing fracture to that leg.

Based on observation, interview, and facility policy review, the facility failed to ensure all hot food items were held above 135 degrees on the steam table to prevent food borne illness. The facility also failed to ensure that all expired foods were removed from the cooler located in the main kitchen as well as ensuring that all food was labeled and dated. This deficient practice had the potential to effect 79 of 88 resident that receive regular or mechanical soft textured diet. Findings include: Observation on [DATE] at 11:46 p.m. of the facility main kitchen walk-in cooler revealed the following food items stored in cooler beyond the expiration date; Pimento Cheese spread 5 pound (lb.) container expiration date [DATE], Lactose Free Whole Milk half gallon (3) expiration date [DATE], Cottage Cheese 5 lb. container expiration date [DATE]. There were also food items that were not labeled and dated as well as food items that were spoiled that were stored in cooler. A head of leafy green lettuce was wilted with red and black discoloration noted, three cabbage heads cut in half with black substances noted on the outer leaves, one cabbage cut in half in a zip lock bag that was not labeled or dated, ,d+[DATE] white onion in zip lock bag not labeled or dated, 5 lb. bag of 5 Flavor pizza cheese not labeled or dated. All food items were confirmed by Dietary Manager (DM) as unlabeled or expired at time of observation. Observation on [DATE] at 12:30 p.m. revealed the DM assisting with obtaining hot food temperatures on the steam table using the facility's calibrated thermometer. Steam table temperatures were obtained halfway through lunch meal service. Observation of food temps revealed pureed vegetable blend was 130 degrees, pureed Philly Cheese Steak was 125 degrees, Alternate meal hamburger steak was 130 degrees, gravy was 124 degrees, and mashed potatoes were 130 degrees. Staff reheated food items in main kitchen food blower at 12:35 p.m., removed food from blower at 12:40 p.m. Food temps: pureed vegetable blend was 134 degrees, pureed Philly Cheese Steak was 135 degrees, Alternate meal hamburger steak was 142 degrees, and gravy was 135 degrees. During an interview on [DATE] at 12:45 p.m. the DM confirmed the food temperatures and expired and unlabeled foods at time of observation. The DM stated that hot foods should be at least 135 degrees on the steam table and foods should be discarded on or before expiration date. On [DATE] at 2:00 p.m. interview with Administrator revealed there were no systems in place to ensure that the food temps are kept at appropriate temp and for food items to be discarded if expired. Further interview also revealed the cook that was in the kitchen was in training and will be in-serviced on the proper food temps and expiration of food items as well. Review of facility undated policy titled Food Storage/Leftovers number 1. Leftovers should not be kept no longer than 7 days, 3. leftovers should be covered, dated, labeled, and refrigerated below 41 degree or frozen.

Based on observations, staff interviews and policy review, the facility failed to follow Transmission Based Precautions (TBP) related to wearing appropriate Personal Protective Equipment (PPE) to prevent potential exposure for new admission residents on isolation precautions, in two of seven rooms (408 and 412) on the 400 Hall Isolation Unit. Findings include: Review of facility policy titled Health Management Quarantine and Isolation Protocol, dated 11/13/2020 revealed, Quarantine and Isolation Protocol revealed Quarantine for COVID-19 should last for a period of 14 days after the potential exposure. Protocol: use of mask and shield when not in high contact with resident activities and use of full PPE (Enhanced Barrier Precautions: mask, gloves, gown, and shield) when in high contact with resident care activities. Observation on 6/22/2021 at 9:44 a.m., revealed room [ROOM NUMBER] door open with signage on the door indicating resident was on enhanced barrier precautions, requiring staff to clean their hands before entering and after exiting room and they must wear gown, mask, face shield and gloves. Licensed Practical Nurse (LPN) AA was observed wearing a face mask and sanitized her hands before entering resident room, but did not don the required PPE (gown, gloves, or face shield) before entering the resident's room. LPN AA was observed to provide care to resident without sanitizing her hands when exiting the residents room. Observation on 6/22/2021 at 9:50 a.m. revealed Certified Nursing Assistant (CNA) BB, walking from 300 Hall to 400 Hall. She sanitized her hands and donned a pair of gloves she pulled from her pocket. She then entered room [ROOM NUMBER], with room door ajar and signage that resident is on enhanced barrier precautions. CNA BB was wearing a face mask but did not don a gown or face shield prior to entering the resident's room. Observation on 6/22/2021 at 10:03 a.m. revealed room [ROOM NUMBER] with signage on the door indicating resident was on enhanced barrier precautions, requiring staff to clean their hands before entering and after exiting room and they must wear gown, mask, face shield and gloves. LPN AA was wearing a face mask and sanitized her hands before entering resident room, but did not don the required PPE (gown, gloves, or face shield) before entering the resident's room. Observation on 6/22/2021 at 10:17 a.m. CNA BB walked from Nurse's Station to room [ROOM NUMBER]. The door to the room was open. CNA BB entered room [ROOM NUMBER] to retrieve the meal tray. She did not don PPE or sanitize her hands before entering or after exiting the room. Observation on 6/23/2021 at 12:39 p.m. revealed CNA BB delivered meal tray to resident in room [ROOM NUMBER], only wearing a face mask. She did not don gown, gloves, or face shield prior to entering room. She did not sanitize her hands after leaving the room. Observation on 6/23/2021 at 12:44 p.m. revealed CNA BB delivered meal tray to room [ROOM NUMBER], only wearing a face mask. She did not don gown, gloves, or face shield. Observation on 6/23/2021 at 12:48 p.m. revealed LPN AA administering medication to resident in room [ROOM NUMBER]. LPN AA sanitized her hands prior to entering the room, but did not don gown, gloves, or face shield. Observation on 6/23/2021 at 12:56 p.m. revealed LPN AA administering medication to resident in room [ROOM NUMBER]. LPN AA sanitized her hands prior to entering the room, but did not don gown, gloves, or face shield. Interview on 6/23/2021 at 1:02 p.m. with LPN AA, confirmed she failed to use the full PPE as the posted sign indicated. She revealed that staff are to wear full PPE for residents on TBP. She verified that full PPE consisted of gown, gloves, masks, and face shield. Interview on 6/23/2021 at 1:11 p.m. with CNA BB, confirmed she failed to comply with wearing the full PPE with residents on TBP. Interview on 6/24/2021 at 10:30 a.m. with Infection Control Preventionist (ICP), revealed when residents are on TBP and staff have contact with residents' body, they should be wearing full PPE. During further interview, she stated that if there is no body contact with the residents, a face mask and face shield is all that is needed. She stated that residents in room [ROOM NUMBER] and 412 are new admissions and have not been vaccinated for COVID-19. During further interview, she stated that the doors to the rooms on the 400 Hall should be closed. Interview on 6/24/2021 at 11:00 a.m. with Director of Nursing (DON), revealed staff should be donning full PPE including gown, mask, gloves, and face shield, when caring for residents on the 400 Hall. She further stated that non-vaccinated admissions are on quarantine for 14 days. Interview on 6/24/2021 at 11:15 a.m. with Administrator, revealed that staff should be wearing full PPE when caring for residents on TBP. She stated that staff should be wearing gowns, gloves, face masks and face shield when caring for residents on TBP and using hand sanitizer.

Based on observations, record review, and interview it was determined that the facility failed to ensure the comprehensive assessement was appropriately coded for oral/dental status for one (1) resident (R) #68, the facility also failed to appropiately assess and code the swallowing status for one (1) resident (R) #166 with a feeding tube. The census sample size was 25. Finding include: Record review revealed the Resident #68 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Annual Minimum Data Set (MDS) assessment dated [DATE], section V- Care Area Assessment (CAA) triggered areas revealed that Oral/Dental status care area was not identified as a triggered area. Further review of section C- cognitive pattern revealed the resident has a Brief Interview for Mental Status (BIMS) score of 15 cognitively intact. Review of section G- functional status, eating, revealed the resident required supervision with setup help only. On 08/02/2017 at 4:33 p.m., during an interview with R#68 revealed she has some broken teeth at the bottom and she has a upper partial in place. The resident stated she had dentures at one time but left them at a different facility. R#68 stated she has seen the mobile dentist that comes to the facility, and she is pleased with the service they offer her. On 08/03/2017 at 8:57 a.m., during an interview with the MDS Coordinator Licensed Practical Nurse (LPN) CC revealed R#68 oral dental status did not trigger on the annual MDS assessment dated [DATE] to reflect R#68 missing or broken teeth. The interview revealed the resident's dental status has not changed from 3/18/16 and confirmed the resident has missing/broken teeth and continues to have missing/broken teeth. CC stated, the process for a resident that is edentulous or has missing/broken teeth, is to properly code the resident's dental status in the CAA, and on the MDS section L- oral/ dental status then properly care plan the issues. Which was not done. On 08/03/2017 at 9:37 a.m., interview with the Social Service Director (SSD) revealed R#68 had a consult with the mobile dentist on 6/12/17. Results of the dental consult revealed a recommendation for extraction of broken teeth. 2. Record review for R#166 revealed the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated in Section K: Swallowing/ Nutritional Status, the resident was not coded as having a feeding tube. Review of the Physician order [REDACTED]. Review of the Medication Administration Report (MAR) for July 2017 revealed that R#166 was receiving bolus [DEVICE] nutrition five times a day as ordered. During an interview on 8/3/17 at 11:45 a.m., MDS Coordinator LPN BB confirmed that Section K of the most recent MDS dated [DATE] was not coded correctly to include R#166's feeding tube. Continued interview revealed that it is the responsibility of the Dietary Manager (DM) to complete Section K of the MDS. Interview on 8/3/17 at 11:50 a.m., the DM revealed that he missed Section K on the MDS dated [DATE] and it should have been checked yes for feeding tube.

Based on observation and resident and staff interview, it was determined that the facility failed to post the most recent State Agency (SA) survey results in an area accessible to residents/family members without the residents/family members having to ask staff to review them. The census was 71 residents. Findings include: During an interview with the Resident Council President on 7/31/17 at 1:50 p.m., she stated that she did not know if the most recent SA survey results were accessible for review by residents and family without having to ask staff. Observation on 8/1/17 beginning at 9:00 a.m. of the 100, 200, 300, 400, and 500 hallways and various lobbies and activity areas revealed there was no location, whereby, the most recent SA survey results could be obtained without asking staff. Observation on 8/1/17 at 11:32 a.m. revealed a memo posted in a large glass case in the main entrance hallway that documented Annual Survey: Our latest survey results are available for review in the Receptionist Office. Interview on 8/2/17 at 2:26 p.m. with the Payroll and Human Resources Assistant revealed that if a resident or family member wanted to review the most recent SA survey results, they had to request the survey results from the Receptionist and the Receptionist would give it to them. Interview on 8/2/17 at 3:50 p.m., with the Administrator revealed that the results of the most recent SA survey were available at the Receptionist's Desk and at the Nurse's Station upon request.

Based on record review and staff interview the facility failed to properly assess one (1) resident #41 for antidepressant medication and one (1) resident #9 for use of foley cather on their Minimum Data Set (MDS) from a sample size of twenty two (22) residents. Findings include: Record review of resident # 41 readmitted on [DATE] with a [DIAGNOSES REDACTED]. A physician's orders [REDACTED]. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed no indication of an antidepressant medication being used. The Care Assessment Area (CAA) revealed Behavioral symptoms. Review of the Electronic Medication Administration Record [REDACTED]. Interview on 10/22/2015 at 12:04:56 p.m. with the Director of Nursing (DON) revealed it is the responsibility of the MDS coordinators to enter the correct data into the residents MDS. She continued to reveal that she expects them to obtain the most accurate information for the resident. Interview on 10/22/2015 at 1:08 p.m. with MDS coordinator FF Registered Nurse, (RN) confirmed that there was no antidepressant medication indicated on the MDS. She continued to reveal that the antidepressant medication should have been counted if it was given. Review of the Admission MDS assessment dated [DATE] indicates that resident #9 is not using any appliances, although resident continues to have a Foley catheter in place from his admission on 9/28/2015. Interview with the DON on 10/21/2015 at 8:15 a.m. revealed that she agreed that staff failed to accurately record use of foley cather use on the MDS assessment.

Based on observation, record review, and staff interview, the facility failed to develop a care plan related to identified dental issues for one (1) resident (#1), and failed to develop a care plan related to antipsychotic drug use for one (1) resident (#7). The sample size was twenty-two (22) residents. Findings include: 1. Observation of resident #1's dental status on 10/21/15 at 9:30 a.m. revealed that he have teeth on the bottom gums, with a few remaining teeth on the upper gums. Review of a Dentist's Progress Notes dated 04/20/15 revealed that the resident was edentulous (without teeth) on the lower with only three remaining teeth on the upper. Continued review of the Dentist's report revealed that future extractions were likely but physical status may prevent extractions. Review of the Oral/Dental Status section of resident #1's Annual Minimum Data Set ((MDS) dated [DATE] revealed that he was coded as having no natural teeth or tooth fragments, and obvious or likely cavity or broken natural teeth. Continued review of the Care Area Assessment Summary (CAAS) for this MDS revealed that Dental Care triggered, with the decision made to care plan for it. Review of resident #1's care plans revealed that no care plans were found related to dental issues. Interview with MDS Coordinator FF on 10/22/15 at 10:52 a.m., she verified that Dental Care triggered on the CAAS on 04/09/15, and that a dental care plan had not been developed. Interview with MDS Coordinator GG at this same time, she stated that if a care area triggered on the CAAS and the decision was made to care plan for it, than a care plan should have been developed. 2. Record review of the physician orders [REDACTED]. A subsequent order was received on July 23, 2015 that increased the [MEDICATION NAME] dosage to 50 mg every 8 hours. Record review of resident #7 care plan revealed that there was no care plan addressing the use of antipsychotic medications. Interview with the Director of Nursing (DON) on 10/21/15 at 2:50 p.m. confirmed that there was no care plan for antipsychotic drug use.

Based on record review and interview the facility failed to obtain a physician's order for the use of [REDACTED]. Findings include: Observed resident on 10/20/2015 at 10:29 a.m. it was noted that the resident ' s catheter had no tension strap in place and the urine bag was full and uncovered. Record review of resident #9 dated 9/28/15 revealed the resident was admitted to the facility on [DATE] with a Foley catheter in place. Record Review of the Admission Minimum (MDS) data set [DATE] revealed staff documented the resident had a Foley catheter upon admission to the facility. A physician's order was not obtained for the indwelling catheter or catheter care until the 10/20/2015 Interview with LPN ' s ' AA ' and ' BB ' on 10/20/15 at 10:29 and they acknowledged that they did not have orders for the catheter and no records of catheter care being provided.

Based on record review and interview, the facility failed to ensure that the clinical record contained sufficient information to accurately reflect foley catheter care and output for one (1) resident( #9) out of a sample of twenty two (22) residents. Review of the resident ' s Medical Chart on 10/20/2015 reveals no orders for the resident's catheter and no Nursing notes for catheter care. Interview with the Administrator on 10/20/2015 at 3:50 p.m. reveals that LPN ' s and CNA ' s are responsible for catheter care and it should be recorded in the Nurses Notes. The Administrator was able to produce LPN records of the amount of urine emptied from resident ' s catheter bag with one entry each on 10/16/2015, 10/19/2015 and 10/18/2015.

Based on record review and staff and family interviews the facility failed to provide a thirty (30)day written notice of transfer or discharge to eight (8) (#4, #7,#11, #12, "A", "B", "C", "D") of twelve (12) sampled residents who were transferred to other nursing homes. The census was forty five (45). Findings include: During an interview with the Administrator on 3/17/15 at 9:40 a.m. and on 3/18/15 at 11:30 a.m., he stated that a new building was currently being built and no residents had been moved to that building because it was still under construction. He said that he did not know when the building would be completed. He added that the present Peachbelt Health and Rehab building would be demolished and would no longer exist. He further stated that the certification for the 106 beds at Peachbelt would be used at the new building. The Administrator admitted that they have not given an official transfer/discharge notice to residents or their families because they did not have an official closing date. They have been verbally telling family members that visited often of the upcoming closing of the building. He reported that the facility formed a transition team and discussed the move the week of 2/23/15 and identified residents that had good family support. The transition team selected twenty residents based on the above criteria to verbally notify their families of the building closing. Twelve (12) records were sampled of residents that were identified by the Transition Team and transferred into other nursing homes: 1. Review of the medical record for resident #4 revealed documentation in the 2/27/15 Social Services notes that the resident would transfer to another nursing home on that day per family request. 2. Review of the medical record for resident #7 revealed documentation in the 2/27/15 Social Services notes that the resident was transferred to another nursing home per family request. 3. Review of the medical record for resident #11 revealed documentation in the 3/11/15 Health Status note that the resident was transferred to another nursing home. 4. Review of the medical record for resident #12 revealed documentation in the 3/11/15 Health Status note that the resident was discharged to another nursing home. 5. Review of the medical record for resident "A" revealed documentation in the 2/27/15 Health Status notes that the resident was transferred to another nursing home per family request. During a telephone interview with the resident's family on 3/18/15 at 10:48 a.m., revealed that someone from the facility called him/her and informed him/her of the facility closing. He/She stated that the person told him/her the resident had to be transferred right away. He/She stated that the facility informed him/her of two (2) beds that were available at other nursing homes. He/She stated that resident "A" was transferred to another facility three (3) days later. He/She further stated that he/she never received a 30 day notice of the intent to transfer the resident. 6. Review of the medical record for resident "B" revealed documentation in the 2/27/15 Social Services Note that the resident would be transferred to another nursing home today per family request. During a telephone interview with the resident's family member 3/18/15 at 11:00 a.m., who stated that someone called him/her from the facility on a Tuesday of the facility closing. He/She stated he/she was given names of other nursing homes but was told he/she had to make a decision by Friday at 5:00 p.m. He/she stated that he/she never received an advanced notice of transfer/discharge. 7. Review of the medical record for resident "C" revealed documentation in the 3/6/15 Social Services Note that the resident was transferred to another nursing home per resident and family request. During a telephone interview with the resident's family on 3/18/15 at 2:25 p.m., revealed that he/she got a phone call from someone at the facility about three (3) weeks ago informing her/him that the facility was closing and they were transferring all of the residents. He/She stated that she never received a 30 day notice of transfer/discharge. 8. Review of the medical record for resident "D" revealed documentation in the 3/5/15 Social Service Notes that the resident was discharged to another nursing home per family request. During a telephone interview with the resident's family on 3/18/15 at 2:45 p.m., she stated that someone from the facility called her about two (2) weeks ago and told her the facility was closing and they were moving the residents out. She stated the person apologized for the short notice but stated that they had to move as soon as possible. She stated that she never received a thirty (30) day notice of transfer/discharge. During an interview with the Administrator on 3/18/15 at 11:30 a.m., he confirmed that none of the above residents had received an advanced thirty (30) day notice of the intent to transfer or discharge the residents.

Based on observation, record review, and staff interviews the facility failed to follow the Care Plan for a personal alarm while in bed for one (1) resident (#117), with a history of falls, of twenty three (23) sampled residents. Findings Include: Review of the Care Plan for resident #117 revealed that the resident was admitted on [DATE] with the [DIAGNOSES REDACTED]. Review of Admission Minimum Data Set ((MDS) dated [DATE] revealed the resident was assessed as having a Brief Interview for Mental Status (BIMS) of five (5) indicating the resident was cognitively impaired. The resident was assessed as not being a fall risk and having no falls within the last six (6) months of admission. The resident is assessed as requiring extensive assist by one (1) person for bed mobility, dressing, toileting, and personal hygiene. The resident was assessed for extensive assist by two (2) persons for transfer. Review of the Quarterly MDS assessment dated [DATE] revealed that the resident was assessed as having a BIMS of six (6) indicating the resident was cognitively impaired. The resident was assessed for one (1) person extensive assistance for bed mobility, transfer, eating, and personal hygiene and bathing the resident was totally dependent upon staff. Review of the nurses notes revealed the following falls: 11/1/14 at 2:45 p.m. resident was found on the floor of his/her room, no injuries noted. Resident states he/she attempting to go to the toilet. 11/7/14 at 2:45 p.m. resident was found on the floor of his/her room with hard stool found on floor, no injuries noted. 12/27/14 at 5:05 a.m. revealed the resident was found on the floor of his/her room and appeared to get out of bed without assistance. Noted the resident had a bowel movement in the bed, diaper and floor. No injuries were noted. Review of the resident care plan related to falls dated 8/18/14 revealed the following interventions: 1. a "personal alarm on when I am in the bed". 2. Ensure oxygen nasal cannula is intact as resident removes it. 3. Environment change, bed against wall per family request 4. Fall risk assessment per protocol 5. Bed in low position 6. Nonskid socks 7. Fall mat beside my bed 8. Therapy evaluation 9. urinalysis/culture and sensitivity Observations on 1/13/15 at 4:00 p.m., 1/14/15 at 8:45 a.m., 12:10 p.m., 1:10 p.m., 1:20 p.m., 2:30 p.m., 4:15 p.m., and 4:19 p.m. revealed that the resident was laying in the bed without a personal alarm attached. Interview on 1/14/15 at 8:50 a.m. with CNA "DD" revealed that the resident does not use a personal alarm while in bed. Interview on 1/14/15 at 4:20 p.m. with Licensed Practical Nurse (LPN) "AA" revealed that the resident is not one of the residents who uses a personal alarm while in bed. Cross refer to F323

Based on observation, record review, and staff interviews the facility failed to ensure that a personal alarm was utilized for while in bed for one (1) resident (#117), with a history of falls, of twenty three (23) sampled residents. Findings Include: Review of the Care Plan for resident #117 revealed that the resident was admitted on [DATE] with the [DIAGNOSES REDACTED]. Review of Admission Minimum Data Set ((MDS) dated [DATE] revealed the resident was assessed as having a Brief Interview for Mental Status (BIMS) of five (5) indicating the resident is cognitively impaired. The resident was assessed as not being a fall risk and having no falls within the last six (6) months of admission. The resident was assessed as requiring extensive assist by one (1) person for bed mobility, dressing, toileting, and personal hygiene. The resident was assessed for extensive assist by two (2) persons for transfer. Review of the Quarterly MDS assessment dated [DATE] revealed that the resident was assessed as having a BIMS of six (6) indicating the resident was cognitively impaired. The resident was assessed for one (1) person extensive assistance for bed mobility, transfer, eating, and personal hygiene and bathing the resident is totally dependent upon staff. Review of the nurses notes revealed the following falls: 11/1/14 at 2:45 p.m. resident was found on the floor of his/her room, no injuries noted. Resident states he/she attempting to go to the toilet. 11/7/14 at 2:45 p.m. resident was found on the floor of his/her room with hard stool found on floor, no injuries noted. 12/27/14 at 5:05 a.m. revealed the resident was found on the floor of his/her room and appeared to get out of bed without assistance. Noted the resident had a bowel movement in the bed, diaper and floor. No injuries were noted. Review of the resident care plan related to falls dated 8/18/14 revealed the following interventions: 1. a "personal alarm on when I am in the bed". 2. Ensure oxygen nasal cannula is intact as resident removes it. 3. Environment change, bed against wall per family request 4. Fall risk assessment per protocol 5. Bed in low position 6. Nonskid socks 7. Fall mat beside my bed 8. Therapy evaluation 9. urinalysis/culture and sensitivity Observations on 1/13/15 at 4:00 p.m., 1/14/15 at 8:45 a.m., 12:10 p.m., 1:10 p.m., 1:20 p.m., 2:30 p.m., 4:15 p.m., and 4:19 p.m. revealed that the resident was laying in the bed without a personal alarm attached. Interview on 1/13/15 at 4:10 p.m. with Certified Nursing Assistant (CNA) "BB" revealed that staff moved the resident's bed in order to have one (1) side against the wall after a fall, the resident has a low bed and floor mats. Interview on 1/14/15 at 8:50 a.m. with CNA "DD" revealed that the resident does not use a personal alarm while in bed. Interview on 1/14/15 at 4:20 p.m. with Licensed Practical Nurse (LPN) "AA" revealed that the resident is not one of the residents who uses a personal alarm while in bed.

Based on resident interview, staff interviews, record review, and policy review, the facility failed to make an effort to resolve a grievance in a timely manner for one (1) resident (#83) from a sample of thirty (30) residents. Findings include: Review of the medical record for resident "B" revealed that the resident's quarterly Minimum Data Set (MDS) assessment revealed a Brief Inventory of Mental Status (BIMS) score of fifteen (15). The resident was alert, oriented, and able to make needs known. Interview on 04-24-13 at 8:00 a.m. with resident "B" had concerns about Licensed Practical Nurse (LPN) "CC". The resident stated that the nurse had a bad attitude toward him. Continued interview revealed that the resident met with the Director of Nursing (DON), a few weeks ago, in her office, and reported his concerns regarding the nurses bad attitude, explaining that the DON just listened and did not ask about the situation, what was meant by bad attitude, or what the nurse was saying or doing to make him feel that way. Interview on 04-24-13 at 8:00 a.m. with the Director of Nursing (DON) and the Administrator revealed that resident "B" had come and told her that LPN "CC" had a bad attitude toward him. The DON indicated that the resident was to follow up with the Social Service Director. Continued interview revealed that a Grievance report was not filled out and nothing was documented and there was no follow up with the resident or the Social Service Director, Review of the facility Resident Complaint Procedures policy revealed that a resident, representative, family member, visitor or advocate may file a verbal or written complaint concerning treatment of [REDACTED]. Interview with Registered Nurse (RN) "BB" revealed that if a resident was to state or indicate that a staff member had a bad attitude toward a resident, the matter should be followed up with, reported, and investigated for possible abuse. continued interview further revealed that the resident will be questioned on what is meant by a bad attitude. The staff member would be questioned. The Administrator would be notified and an investigation would be done.

Based on observation, record review and staff interview, the facility failed to ensure that dignity was maintained related to dining for one (1) resident ("A") from a sample of thirty (30) residents. Findings include: Observation of resident "A" on 4/23/13 at 1:15 p.m. revealed she left the dining room before her lunch was served. Resident "A's" table was the last table served. Review of the resident's quarterly Minimum Data Set assessment dated [DATE] revealed a Brief Inventory of Mental Status of 15, indicating she was cognitively intact. Interview with the resident on 4/23/13 at 1:53 p.m. revealed that she goes to [MEDICAL TREATMENT] on Tuesdays, Thursdays, and Saturdays; when she came back from [MEDICAL TREATMENT] on 4/23/13 (Tuesday) at 11:00 a.m. she went directly to the dining room and told the staff what she wanted for lunch, then waited. Continued interview revealed the staff served the entire dining room, including the other two (2) residents at her table, but she did not get served. She left the dining room and staff brought her lunch to her room. She refused to eat lunch, as she revealed she did not want to eat if she could not eat with everyone else. Interview with the resident on 4/25/13 at 1:50 p.m. revealed It hurts her feelings when she gets served her meal last; the incident on 4/23/13 made her feel like the staff do not care about her. continued interview revealed that the Dietary Manager told her it took a while to cook her hamburger but she stayed in the dining room until at least 5 minutes after her two table-mates were served, and her friend was half finished with her lunch. Interview with the Dietary Manager on 4/25/13 at 3:05 p.m. revealed there are short-order cooks in the kitchen at lunch time to cook the alternates; hamburgers are always an alternate for lunch. She revealed resident "A's" table is always served last; she was not aware the resident had requested a hamburger for lunch until lunch was being served, and she wanted the resident's hamburger to be hot when it was served. She was aware the resident was upset and left the dining room, found her in the hallway and asked her to come back to the dining room to eat lunch.

Based on observations, record review and staff interviews the facility failed to provide reasonable accommodation of individual need and preference related to the use of a wheelchair for one (1) resident ("Z") from a sample of thirty (30) residents. Findings include: Observation on 4/23/13 at 2:15 p.m. revealed resident "Z" seated in a geri-chair in the area in front of the 200 Hall nurse's station. The resident had a left hand splint in place. Review of the medical record revealed resident "Z" was admitted on [DATE] from another long term care facility with the [DIAGNOSES REDACTED]. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident participated in his assessment and that the assessment revealed all daily personal preferences were very important to the resident. The Basic Inventory of Mental Status (BIMS) score was assessed at fifteen (15) indicating that the resident was cognitively intact. Interview on 4/23/13 at 2:29 p.m. with resident "Z" revealed he was usually made to go back to bed after breakfast and stayed in bed until the staff got him out of bed for lunch. The resident indicated that he went back to bed after lunch until about 4:30 p.m. when he was assisted out of bed in time for dinner. Continued interview revealed he would rather be in a wheelchair so he could propel himself around the facility and that if the survey team was not there, he would probably be in bed. Further interview revealed that the resident has therapy in the mornings. Review of the medical record revealed a care plan dated 4/16/13 for a history of [MEDICAL CONDITION] left sided weakness; resident was admitted with contractures to the left upper extremity (LUE); Occupational Therapy (OT) evaluated and treated the resident with the use of range of motion (ROM) exercises and the application of a splint. Interventions were activity as tolerated and up, out of bed (OOB) in a geri-chair as tolerated. Observations on 4/24/13 at 7:20 a.m. revealed resident "Z" dressed and propelling himself down the hall toward the dining room in a wheelchair without assistance, on 4/24/13 at 10:18 a.m. and 2:58 p.m. propelling himself in the wheelchair to use the telephone at the nurses desk, on 4/25/13 at 7:14 a.m. propelling himself in the wheelchair to the dining room for breakfast and on 4/25/13 at 8:17 a.m. propelling himself down the hall to his room. Interview on 4/24/13 at 7:20 a.m. with resident "Z" revealed he was given the wheelchair last night (4/23/113). Interview on 4/24/13 at 9:45 am with Licensed Practical Nurse (LPN) "EE" revealed he was not aware that the resident wanted a wheelchair and that the resident liked to lie back in the geri-chair when he was up. Continued interview revealed that the LPN was very surprised when he saw the resident in a wheelchair this morning and propelling himself around the facility. Interview on 4/25/13 at 12:52 p.m. with LPN "EE" revealed that since resident "Z" had been up in a wheelchair the last two days, he had been able to stand to use the toilet. Interview on 4/25/13 at 2:48 p.m. with resident "Z" revealed he had a wheelchair at the facility where he lived prior to his admission to this facility. He revealed he asked this facility several times for assistance to get his wheelchair, but he had not been able to get the chair from the other facility. Continued interview revealed he had Physical Therapy for his hand and foot (left) when he came to the present facility and Therapy had indicated they were going to see about getting him a wheelchair but since being at this facility, he has been in a geri-chair. The resident revealed it made him feel bad to be sitting in the geri-chair as he could not propel the chair and he would be left sitting where they put him until someone else came to move him again. Further interview revealed that he was now able to propel himself to use the telephone when he wants to and can propel himself to the activities of his choice. The resident revealed he was aware when he needs to go to the bathroom, but he was not able to use a urinal due to the limited use of his left hand and leg and he often needed to go to the bathroom right after breakfast, but the staff was busy assisting other residents and so he used the brief. He has been assisted to the toilet to stand and use the toilet in the shower room since he received the wheelchair and he was happy to be able to do that. The resident was observed to become teary during this interview while talking about his condition without a wheel chair. Interview on 4/25/13 at 3:06 p.m. with the Rehabilitation Manager revealed the resident did not have a wheelchair when he was admitted to the facility on [DATE]. He was evaluated by Physical Therapy (PT) and had services from 3/27/13 to 4/15/13 with goals for a restorative program. The prior facility assessment information was available to the PT department. His prior level was in a wheelchair and they were to try to look into getting him into a wheelchair. Review of the PT and Occupational Therapy (OT) notes of 3/25/13 revealed the resident was to be assessed for a wheelchair. Continued review revealed Physical Therapy services were discontinued as of 4/15/13; Occupational Therapy services were discontinued on 4/16/13. Interview on 4/25/13 at 4:35 p.m. with Registered Nurse (RN) "BB" revealed she had contacted the resident's wife and she confirmed that the resident was in a wheelchair in the previous facility. Continued interview revealed PT would be the discipline to have evaluated the resident for a wheelchair at this facility and PT did not evaluate and suggest a wheelchair. Observation on 4/26/13 at 7:44 am revealed resident "Z" was dressed and sitting in the dining room waiting for breakfast to be served. Interview at this time with the resident revealed he was happy to have the wheelchair and was feeling better. Interview on 4/26/13 at 10:21 am with CNA "FF" revealed Resident #72 was doing much better with his activity level and toileting since he was put into the wheelchair "The geri-chair was ok, but the wheelchair makes it easier" for his toileting needs and other care. He was now assisted to the shower room for toileting at times during the day. Interview on 4/26/13 at 10:28 am with the Rehabilitation Manager revealed he had been told by the Social Services Director and Nursing that the previous facility was contacted regarding the resident's wheelchair. He revealed the resident did talk about his wheelchair, but the resident was not assessed in a wheelchair. The Rehabilitation Manager did not know how it was determined to put the resident in a geri-chair when he arrived without a wheelchair. If a resident needed a wheelchair when they arrived at the facility, they went "to the shed" and found a suitable wheelchair for them. The Rehabilitation Manager confirmed there was no documentation that resident "Z" was assessed in a wheelchair. The facility failed to provide resident "Z" with a wheelchair instead of a geri-chair to enhance the resident's independence, dignity and respect his individuality.

Based on observation and staff interview the facility failed to ensure sanitary conditions were maintained to prevent cross contamination regarding unlabeled personal care items in three (3) rooms on two (2) of two (2) halls. Findings include: Observations during Initial Tour of the facility on 4/23/13 beginning at 11:30 a.m. revealed the following: A Hall: -Room207 A and B-Unlabeled personal items sitting on top of the counter top next to the sink including an eighteen (18) ounce bottle of Act Anticavity mouthwash, one (1) Stay Away Plus denture cleanser, one (1) Fresh mint toothpaste, 1 white toothbrush (short), and one (1)yellow tooth brush, one (1) four (4) fluid ounce bottle of Sweet oil, and one (1) Medi choice deodorant 1.5 fluid ounces. Observations on 4/23/13 at 11:40 a.m., 4/24/13 at 9:30 a.m., 4/24/13 at 5:00 p.m., 4/25/13 at 9:00 a.m., 4/25/13 at 1:30 p.m., 4/25/13 at 5:00 p.m., and 4/26/13 at 9:00 a.m. and 11:00 a.m. revealed the same findings. There were two residents in this room. -room [ROOM NUMBER] A and B-Unlabeled personal care items that included one (1) blue razor, one (1) fresh mint mouthwash, two (2) greenish blue toothbrushes, one (1) in a plastic wrapper and the other tooth brush not in a container, one (1) twenty four (24) fluid ounce Silkience Skin care Body lotion. Observations on 4/23/13 at 11:45 a.m., 4/24/13 at 5:00 p.m., 4/25/13 at 9:30 a.m., 4/25/13 at 1:30 p.m., and 4/26/13 at 9:05 a.m. revealed the same findings. There were two resident in this room. B Hall: Observation of room [ROOM NUMBER] A and B at 1:00 p.m. on 4/23/13, revealed the following unlabeled personal care items: On the left of the sink, one (1) gold razor on top of the sink, one (1) wet blue wash cloth, one (1) open Crest toothpaste one (1) purplish and white toothbrush, and one (1) four (4) fluid ounce bottle of Fresh Mint mouthwash. On the right of the sink, 1.5 fluid ounces medi choice deodorant, one (1) Aqua Fresh tooth paste, and one (1) white denture cup with red trim containing water. Observations on 4/23/13 at 1:00 p.m., 4/24/13 at 11:15 a.m., 4/24/13 at 5:00 p.m., 4/25/13 at 9:20 a.m., 4/25/13 at 5:00 p.m., and 4/26/13 10:00 a.m. revealed the same findings. There were two resident in this room. Interview with Registered Nurse, (RN) "BB" on 4/26/13 at 11:00 a.m. revealed that these items should be labeled .

Based on record review and staff interview, the facility failed to follow a physician's order for laboratory testing for two (2) residents (#86 and #53) from a sample of thirty (30) residents. Findings include: 1. Review of the clinical record for resident # 86 revealed that the resident was admitted in 3/2012 with End Stage [MEDICAL CONDITIONS] and receives [MEDICAL TREATMENT] three (3) times per week (Monday, Wednesday and Friday). Continued review revealed that the [MEDICAL TREATMENT] Center faxed an order to the facility to obtain a stool for occult blood on 4/10/13. Additionally, record review revealed that Registered Nurse (RN) "BB" wrote a physician's order dated 4/10/13 to obtain stool for occult blood for three times (x3). Review of the laboratory results in the clinical record revealed no evidence that a stool for occult blood had been done on the resident. Interview with RN "BB" at 8:50 a.m. on 4/26/13 revealed she reviewed the record yesterday, 4/25/13, to look for labs and had called the lab to see if a specimen had been sent. The lab confirmed that they had not received a specimen. Continued interview revealed that the nurse had checked with the nursing staff and they had no recollection of obtaining and sending a specimen. 2. Review of the clinical record for resident #53 revealed an order dated 3/3/13 for Complete Blood Count, Comprehensive Metabolic Profile, and [MEDICAL CONDITION] Stimulating Hormone (TSH) next week. Review of the lab results in the resident's clinical record revealed no evidence that the TSH had been done. Interview with Unit Manager "AA" on 4/25/13 at 3:00 p.m. confirmed that there was no evidence that the TSH was obtained for resident #53 as ordered. Continued interview at 4:50 p.m. revealed that the facility we failed to write the requisition for the TSH.

Based on observation, record review and staff interview, the facility failed to follow physician's orders related to medication administration for two (2) residents (#44 and #13) from a sample of thirty-two (32) residents: Findings include: 1. Observation, during medication pass, on 11/30/11 at 9:43 a.m. revealed resident #44 received Aspirin 325 milligrams (mgs), [MEDICATION NAME] 12.5mgs , [MEDICATION NAME] 50mgs and Galantamine 8mgs. Review of the medications ordered on return from the hospital on [DATE] revealed an order for [REDACTED]. Review of the Scheduled Medication Administration Records for November, 2011 revealed that the [MEDICATION NAME] 10mgs had not been administered to the resident since return from the hospital on [DATE]. Interview with the 200 Hall Unit Manager on 11/30/11 at 10:00 a.m. revealed that the [MEDICATION NAME] 10mgs was never transcribed from the admission orders [REDACTED]. 2. Review of the physician's orders for resident #13 revealed an order dated 10/14/11 to change [MEDICATION NAME] 10 mgs, one (1) by mouth every morning to [MEDICATION NAME] 20 mg one (1) by mouth every morning for depression. Review of the Scheduled Med Administration Records for October and November, 2011 revealed no evidence that the [MEDICATION NAME] had been changed from 10mg daily to 20mgs daily as ordered by the physician. The resident continued to receive [MEDICATION NAME] 10 mgs daily from 10/15 thru 11/30/11. Interview with Licensed Practical Nurse "AA" on 12/1/11 at 12:24 p.m. revealed that according to the electronic Medication Administration Record, [REDACTED]. During interview with Unit Manager for 100 hall on 12/1/11 at 12:26 p.m., she confirmed that the order was written on 10/14 to increase the [MEDICATION NAME] to 20 mg daily and that the resident was receiving [MEDICATION NAME] 10 mg daily.