Seminole Pioneer Nursing Home

In the surveyor’s words

From the most serious findings on record at Seminole Pioneer Nursing Home, in the surveyor’s own words.

• Actual harm, patternF689Aug 11, 2023

  Based on observation, record review, and interview, the facility failed to develop and implement interventions and receive adequate supervision to help prevent falls for one (#12) of three sampled residents reviewed for falls. Resident #12 had 12 falls in five months and sustained two closed head injuries. The Resident Census and Conditions of Residents form, dated 08/08/23, documented 45 residents resided in the facility. Findings: Res #12 admitted to the facility on [DATE] with diagnoses which included dementia, atrial fibrillation, and cognitive dysfunction. A fall risk assessment, dated 01/09/23, documented the resident was at high risk for falls. A care plan, dated 01/09/23, documented the following interventions: a. […]

• Actual harm, isolatedF600May 19, 2025

  Based on observation, record review, and interview, the facility failed to ensure residents were free from abuse for 2 (#1 and #3) of 3 sampled residents reviewed for abuse. The administrator identified 44 residents resided in the facility. Findings: An undated facility policy titled 'Allegations of Abuse, Neglect, Exploitation or Mistreatment,' read in part, Definitions: 'Abuse' is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. 1. An undated admission record showed Res #1 had diagnoses which included schizoaffective disorder, mild cognitive impairment, and major depressive disorder. A quarterly assessment, dated 03/10/25, showed the resident was cognitively intact and had a BIMS of 15. […]

• No harm, potential for more than minimal, widespreadF812Nov 5, 2024

  Based on observation and interview, the facility failed to ensure foods in the kitchen were dated and labeled. The administrator reported 50 residents resided in the facility. Findings: On 11/03/24 at 8:45 a.m, a tour of kitchen was conducted. A commercial refrigerator was observed to contain a pitcher of brown liquid, a pitcher of yellow liquid, 11 cups of different colored liquids, and a pitcher of fruit. There were no dates or labels on the food products. On 11/03/24 at 9:21 a.m., [NAME] #1 reported everything in the refrigerator should have been dated and labeled.

• No harm, potential for more than minimal, widespreadF812Aug 11, 2023

  Based on observation and interview, the facility failed to ensure the kitchen was kept clean and maintained to promote food safety and sanitation. The Resident Census and Conditions of Residents report, dated 08/08/23, documented 45 residents resided in the facility. Findings: On 08/10/23 8:51 a.m., a follow-up tour of the kitchen was conducted. The following observations were made: a. an accumulation of lint and a black substance was on the heat/air return vent, b. a thick accumulation of dirt, debris, and a brown and black residue was surrounding the floors by the base boards in the kitchen and both dining rooms, c. an accumulation of black and brown residue was on the wall beside the kitchen refrigerator, d. an an accumulation of white residue was on the sink in the dining room, e. […]

• No harm, potential for more than minimal, patternF656Nov 5, 2024

  Based on observation, record review, and interview, the facility failed to develop a care plan for smoking for one (#32) of one sampled resident reviewed for smoking and failed to develop a care plan for a wound for one (#48) of two sampled residents reviewed for pressure ulcers. The administrator identified eight residents who smoked. MDS Coordinator #1 identified three residents with wounds. Findings: 1. Res #32 had diagnoses which included history of stroke and hypertension. On 11/04/24 at 9:06 a.m., Res #32 was observed on the front porch of the facility smoking a cigarette during the facility designated smoking time. A record review did not document a smoking care plan was developed for Res #32. […]