St Gabriel's Community

In the surveyor’s words

From the most serious findings on record at St Gabriel's Community, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF880Jun 12, 2024

  Based on observation, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 6 of 15 sampled residents (Resident #15, #19, #30, #55, #59, and #65) observed during cares. Failure to practice infection control standards related to use of personal protective equipment (PPE) and hand hygiene has the potential to spread infection throughout the facility. Findings include: Review of the facility policy titled Hand Hygiene occurred on 06/12/24. This policy, dated June 2017, stated, . Hand hygiene simply means cleaning hands using either handwashing (washing hands with soap and water), or antiseptic hand rub (i.e. alcohol-based hand sanitizer, including foam or gel). Times to Perform Hand Hygiene are, but not limited to: . […]

• No harm, potential for more than minimal, patternF880Mar 31, 2022

  Based on observation, review of facility policy, and staff interview, the facility failed to follow infection control practices for 6 of 18 sampled residents (Resident #10, #16, #22, #31, #48, and #121) and two supplemental residents (Resident #15 and #66) observed during cares. Failure to follow infection control practices has the potential for transmission of communicable diseases and infections to residents and staff. Findings include: PERSONAL PROTECTIVE EQUIPMENT (PPE) During the entrance conference, administrative staff provided a list of residents not vaccinated for COVID-19. Signage is placed on the room door and staff is required to wear face shields while in the resident's room. […]

• No harm, potential for more than minimal, patternF550Feb 4, 2021

  THIS IS A REPEAT DEFICIENCY FROM THE SURVEY COMPLETED ON 04/17/19. Based on observation, record review, review of facility policy, and staff interview, the facility failed to provide care for 9 of 19 sampled residents (Resident #3, #4,#17, #31, #35, #36, #40, #57, and #60) in a manner that maintained/enhanced each residents' dignity and individuality. Failure to provide meal assistance, remove transfer belt, and grooming in a dignified manner did not promote the residents' dignity and/or enhance their quality of life. Findings include: Review of the facility policy titled Feeding the Guest occurred on 02/04/21. This policy, revised April 2010, stated, . When feeding guest, sit when possible. […]

• No harm, potential for more than minimal, patternF761Feb 4, 2021

  Based on observation, record review, review of facility policy, and staff interview, the facility failed to ensure accurate labeling and storage of medications for 4 of 36 residents (Resident #9, #16, #21, and #26) and 2 of 3 medication storage areas (Grand Pacific and Prince) observed during medication storage review. Failure to correctly label, store, and dispose of medications may increase the risk of residents receiving an inaccurate dose of medication and/or reduced medication efficacy. Findings include: Review of the facility policy titled Medication Storage in the Facility, Storage of Medications occurred on [DATE]. This policy dated, [DATE], stated, . H. […]

• No harm, potential for more than minimal, isolatedF580Feb 12, 2026

  Based on record review, review of facility policy, and family and staff interview, the facility failed to notify the resident representative for 1 of 1 closed resident (Resident #1) reviewed for wounds/pressure injuries. Failure to notify the resident representative about new wounds/pressure injuries, changes to existing wounds/pressure injuries, and new/changes in treatment orders for these injuries does not allow the resident representative to be informed and make decisions significant to the resident's health and care. Findings include:Review of the facility policy titled Prevention and Treatment of Skin Breakdown occurred on 02/12/26. This policy, dated 2018, stated, . Weekly skin audits are performed by a licensed nurse. If a . new pressure injury or lower extremity wound develops . […]