Shepherd of the Valley Poland

In the surveyor’s words

From the most serious findings on record at Shepherd of the Valley Poland, in the surveyor’s own words.

• Actual harm, isolatedF684Dec 27, 2024

  Based on closed record review, review of emergency room /hospital records, policy review, and interview the facility failed to adequately monitor and provide timely and necessary care and services for an acute change in condition for Resident #27. Actual harm occurred beginning on [DATE] when Resident #27, who had chronic Stage 3 kidney disease, was noted to have an acute change in condition (nausea, vomiting, diarrhea, fatigue and decreased appetite) that was not adequately treated. Between [DATE] and [DATE], the resident continued to exhibit a deterioration in condition including hypotension, poor oral intake and nausea/vomiting and diarrhea. […]

• No harm, potential for more than minimal, isolatedF628May 8, 2026

  Based on record review and interview, the facility failed to ensure Resident #32 had appropriate supports in place for discharge to include discharge medications. This affected one (Resident #32) of three residents reviewed for discharge planning. The facility census was 31. Findings include:Review of Resident #32's medical record revealed the resident was admitted on [DATE] and discharged on 01/10/26 with diagnoses including chronic systolic congestive heart failure, bipolar disorder and pain in the right knee.Review of Resident #32's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition.Review of Resident #32's progress note dated 01/09/26 at 7:53 P.M. […]

• No harm, potential for more than minimal, isolatedF676Sep 18, 2025

  Based on observation, review of the medical record, interview with staff, and review of the facility policy, the facility failed to ensure Resident #1 was shaved per his preferences. This affected one resident (Resident #1) of two reviewed for activities of daily living.Findings Include:Review of the medical record revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included acute respiratory failure, pneumonia, retention of urine, acute cough, radiculopathy, hypertension, glaucoma, heart failure, atherosclerotic heart disease, hyperlipidemia, and chronic kidney disease.Review of the physician's orders revealed Resident #1 had an order for Plavix (blood thinner) 10 milligrams once daily dated 09/04/25.Review of the plan of care dated 09/04/25 revealed Resident #1 was on… […]

• No harm, potential for more than minimal, isolatedF695Sep 18, 2025

  Based on observation, review of the medical record, and interview with staff, the facility failed to ensure the portable oxygen tank for Resident #1 was working properly. This affected one resident (Resident #1) of two residents (Resident #1 and #31) who received oxygen therapy.Findings Include:Review of the medical record revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included acute respiratory failure, pneumonia, retention of urine, acute cough, radiculopathy, hypertension, glaucoma, heart failure, atherosclerotic heart disease, hyperlipidemia, and chronic kidney disease.Review of the physician's orders revealed Resident #1 had an order dated 09/10/25 to wean off oxygen but keep oxygen saturation at 92 precent (normal ranges from 95% to 100%). […]

• No harm, potential for more than minimal, isolatedF580Dec 27, 2024

  Based on record review and interview, the facility failed to ensure the physician was notified of weight gain, low blood pressure and a change in appetite. This affected two (Resident's #5 and #27) of six residents reviewed for notification of changes. The census was 26. Findings include: 1. Review of Resident #5's medical record revealed an 11/20/24 admission with diagnoses including fractured right femur, moderate protein calorie malnutrition, heart failure, asthma, acute cholecystitis, hypertension, hyperlipidemia, atherosclerotic heart disease, paroxysmal atrial fibrillation, anemia, and gastroesophageal heart disease. […]