The Grove Post-Acute Care Center

In the surveyor’s words

From the most serious findings on record at The Grove Post-Acute Care Center, in the surveyor’s own words.

• Immediate jeopardy, patternF880Jan 27, 2022

  Based on observation, interview and record review, the facility failed to provide a safe, sanitary environment to help prevent the spread of infections for Coronavirus Disease 2019 (COVID-19 - a highly contagious respiratory illness in humans capable of producing severe symptoms) in accordance with the facility's Mitigation Plan (MP- a plan to reduce loss of life and impact of COVID-19 in the facility) for 53 of 53 residents who resided in the facility by failing to ensure a confirmed COVID-19 positive staff (Activities Director [AD]) did not provide direct care to green zone residents (residents who have recovered or are clear of COVID-19) nor maintain separation from other staff. This deficient practice increased the risk of spreading COVID-19 infections to residents and staff. […]

• Immediate jeopardy, isolatedF805Dec 31, 2024

  Based on observation, interview, and record review, the facility failed to prepare food in a form designed to meet individual needs (requirements that a person has in order to be well such as food) for one of 62 sampled residents (Resident 214) on puree diet (a texture modified diet that consists of smooth, moist foods that are easy to swallow) by not following the recipes for puree oatmeal, puree scrambled eggs, and puree wheat breads and in accordance with the International Dysphagia Diet Initiative (IDDSI - a framework made up of levels and describes food textures and drink thickness) Level Four (pureed foods and extremely thick drinks) Standards when on 12/29/2024 Resident 214 was served bread soaked in milk, oatmeal with lumps, and scrambled eggs that were not smooth and not pureed. […]

• No harm, potential for more than minimal, widespreadF803Dec 4, 2025

  Based on observation, interview, and record review, the facility failed to follow the menu and did not meet nutritional needs of 59 of 63 residents on regular (diet with no restriction) and therapeutic diets (a meal plan tailored to a resident's specific medical condition to treat or manage it) including Resident 71 when [NAME] 1 did not follow the recipes for regular and puree corn bread for lunch. This failure had the potential to result in decrease in food flavor, decrease in food and nutrient intake resulting in unintended weight loss. […]

• No harm, potential for more than minimal, widespreadF814Dec 31, 2024

  Based on observation, interview, and record review, the facility failed to dispose garbage and refuse properly by: a. Not putting a plastic liner in the trash can used in the kitchen. b. Not completely closing 1 (one) of 2 black dumpsters (large trash container designed to be emptied into a truck). These failures had a potential to result to attracting birds, flies, insects, pest and possibly spread infection to 62 of 63 facility residents. Findings: a. During an initial kitchen tour observation on 12/29/2024 at 7 a.m., the trash can in the kitchen had no plastic liner. During a concurrent observation and interview on 12/29/2024 at 8:30 a.m. […]

• No harm, potential for more than minimal, patternF578Dec 4, 2025

  Based on interview and record review, the facility failed to ensure residents' rights to formulate an Advance Directive (AD - a legal document that outlines an individual's wishes regarding medical care in the event they become incapacitated and unable to communicate their preferences) for three of three sampled residents (Resident 2, 11, and 59) reviewed under the AD care area by failing to: 1. Provide written information concerning the right to formulate an AD for Resident 2 and 11. 2. Ensure a copy of advance directive was readily available in the medical chart for Resident 59. These deficient practices had the potential to violate the resident's right to have their wishes honored regarding health care decisions. Findings: a. […]