Residence at Salem Woods

In the surveyor’s words

From the most serious findings on record at Residence at Salem Woods, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF761Apr 14, 2022

  Based on observation, staff interview, review of medication insert, and policy review, the facility failed to ensure medications were dated after opening and were not expired. This had the potential to affect all 87 residents residing in the facility. The facility census was 87. Findings include: 1. Observation on [DATE] at 1:42 P.M. of the medication storage room revealed two 16-ounce bottles of liquid [MEDICATION(S)] Sodium Stool Softener with an expiration date of ,d+[DATE]. Interview on [DATE] at 1:43 P.M. with Licensed Practical Nurse #36 confirmed the expiration date on the two [MEDICATION(S)] Sodium Stool Softener bottles. 2. Observation on [DATE] at 2:00 P.M. […]

• No harm, potential for more than minimal, patternF804Apr 14, 2022

  Based on observation, staff interview, review of facility recipes, and policy review, the facility failed to properly prepare pureed food. This had the potential to affect all eight facility identified residents (#9, #10, #17, #29, #40, #47, #49, and #56) in the facility who receive a pureed diet. The facility census was 87. Findings include: Observation on 04/12/22 at 9:23 A.M. revealed Cook #21 prepared pureed ham for the lunch meal. Cook #21 stated there was one pureed diet, which was liquified, and the remainder of the pureed diets were standard puree. Cook #21 placed ham into the food processor, turned the food processor on, and then added water to the food processor. Cook #21 continued to add water to the food processor until the ham was a watery consistency. […]

• No harm, potential for more than minimal, isolatedF684May 1, 2025

  Based on medical record review, staff interview, and review of the facility policy, the facility failed to obtain a resident's weight upon admission to the facility. This affected one (#16) resident of the three residents reviewed for weight changes. The facility census was 84 residents. Findings include: Review of the medical record for Resident #16 revealed an admitted [DATE] with diagnoses including diabetes mellitus (DM), dysphagia, and acute kidney failure. Review of the care plan for Resident #16 dated 03/15/25 revealed the resident was at risk for alteration in nutrition and hydration and weight loss related to acute kidney failure, hydronephrosis, DM, fatty liver, anemia and poor intakes. […]

• No harm, potential for more than minimal, isolatedF697May 1, 2025

  Based on medical record review, observation staff interview, review of the facility policy, and review of guidelines from the National Pressure Injury Advisory Panel (NPIAP), the facility failed to ensure resident pain was effectively managed during a dressing change. This affected one (Resident #6) of three residents reviewed for pain management. The facility census was 84 residents. Findings include: Review of the medical record for Resident #6 revealed an admitted [DATE] with diagnoses including diabetes, profound intellectual disabilities, anxiety disorder, and aphasia. Review of the care plan for Resident #6 dated 12/28/11 revealed the resident was unable to verbally express pain. […]

• No harm, potential for more than minimal, isolatedF755Apr 14, 2022

  Based on observation, staff interview, and policy review, the facility failed to properly prepare medications for administration. This had the potential to affect three Residents (#15, #23, and #59) out of 25 residents who reside on the Oak and Pine unit. The facility census was 87. Findings include: Observation on 04/12/22 at 2:59 P.M. of the medication cart on the Oak and Pine unit revealed there were three cups of pre-poured medications prepared for three Residents (#15, #23, and #59) in the top drawer of the cart. Interview with Licensed Practical Nurse (LPN) #80 during the observation on 04/12/22 at 2:59 P.M. […]