The Alverno Health Care Facility

In the surveyor’s words

From the most serious findings on record at The Alverno Health Care Facility, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Feb 1, 2024

  Based on observations, Kitchen Cleaning Schedule review, and staff interviews, the facility failed to properly maintain a clean kitchen for food preparation, storage and serving to prevent food borne illness. The facility reported a census of 81 residents. Findings Include: On 1/29/24 at 10:54 AM during tour of the kitchen, the following areas were noted not to be clean: a. An ice machine on the right side of the entrance to the kitchen had large amounts of white build up on the drain tray. b. The floor horizontal to the pots and pans dish machine next to the stove and food prep area all had large amounts of debris and brown/black thick substance under and around the mats. c. The refrigerators labeled #5, #6, #7, #8 and #9 noted with a white substance running down the front of them. d. […]

• No harm, potential for more than minimal, patternF865Feb 19, 2026

  Based on review of the Centers for Medicare & Medicaid Services Certification and Survey Provider Enhanced Report (CASPER), review of the facility Quality Assurance Performance Improvement (QAPI) plan, and staff interviews the facility failed to implement quality assurance practices to prevent the repeat of citations of deficient practices in the area of infection control and pharmacy services. The facility reported a census of 87 residents. \Findings include: Review of the CASPER revealed the facility had the following repeat deficient practices:F761 - Label/Store Drugs & Biologicals cited during a complaint survey ending on 8/7/25; and the current Recertification survey completed on 2/19/26.F880 - Infection Prevention & Control cited during the Recertification surveys that ended on… […]

• No harm, potential for more than minimal, patternF880Feb 19, 2026

  Based on observations, record review, staff interviews and facility policy review, The facility failed to ensure staff followed contact precautions for 1 of 1 residents (Resident #103) on contact precautions, failed to utilize Enhanced Barrier Precautions correctly effecting 2 of 2 residents (Resident #16 and Resident #52), failed to follow infection control practices to minimize the potential to spread COVID in the Memory Care unit, and failed to cover wet laundry during transport to an operational dryer. The facility reported a census of 87 residents.Findings include:1. Review of the Minimum Data Set (MDS) assessment for Resident #16, dated 12/2/25, revealed a Brief Interview for Mental Status (BIMS) score of 3 out of 15, which indicated a severe cognitive impairment. […]

• No harm, potential for more than minimal, patternF758Feb 6, 2025

  Based on clinical record review, facility policy review and staff interview the facility failed to follow up on pharmacy recommendations for the monitoring of medications and gradual dose reduction for 4 out of 5 residents reviewed. (Residents #2, #20, #45, and #60) The facility identified a census of 91 residents. Findings include: 1. Review of the Minimum Data Set (MDS), dated [DATE] revealed Resident #20 scored 13 out of 15 on the Brief Interview for Mental Status, which indicated intact cognition. […]

• No harm, potential for more than minimal, patternF812Feb 6, 2025

  Based on observation, food storage guidelines, and staff interviews the facility failed to label food, indicate the opened/prepared date of an item, and dispose of food kept beyond the expiration date in an effort to prevent prevent food borne illness. The facility reported a census of 91 residents. Findings include: During the initial kitchen tour on [DATE] at 9:45 AM, the following food items found in a refrigerator with either no label and or date opened, and kept beyond the expiration date: a. Large bag of lettuce in saran wrap, no open date indicated. b. Bag of french fries, no open date indicated. c. Melted butter, no prepared date indicated d. Corned beef, dated [DATE]. e. Zip lock bag with unknown contents, no date indicated. f. Dish of oatmeal, no prepared date indicated. g. […]