The Orchards at Niles

In the surveyor’s words

From the most serious findings on record at The Orchards at Niles, in the surveyor’s own words.

• Actual harm, isolatedF689Apr 7, 2022

  This citation has 2 Deficiency Practice Statements (DPS), 1 and 2. DPS #1: Based on observation, interview, and record review the facility failed to provide adequate supervision for 1 of 3 residents (Resident #68) reviewed for accidents/hazards/supervision, resulting in Resident #68 sustaining a fall with fracture to left femur, left hip and right femur which negatively affected the residents highest practicable physical, mental, and psychosocial well-being. Findings include: Resident #68: Review of Admission Record revealed for Resident #68 was a female, with pertinent diagnoses which included Alzheimer's disease, [CONDITION(S)], anxiety, dementia with behavioral disturbances, [CONDITION(S)] with delusions, restlessness and agitation, sleep disorders, lack of coordination,… […]

• Actual harm, isolatedF692Apr 7, 2022

  This citation pertains to intake MI 388. Based on observation, interview and record review the facility failed to maintain sufficient hydration/nutrition in 4 of 4 residents (Resident #5, #22, #26, and #38) reviewed for hydration/nutrition resulting in weight loss and the potential for dehydration, unmet resident needs, unnecessary negative physical, mental and psychosocial outcomes. Findings include: Resident #26 Review of a Face Sheet revealed Resident #26 was a male, with pertinent diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] Review of a Minimum Data Set (MDS) assessment for Resident #26, with a reference date of 2/3/22, revealed a Brief Interview for Mental Status (BIMS) score of 99 which prompted a staff assessment for Resident #26's cognitive status and revealed a score of 3… […]

• No harm, potential for more than minimal, widespreadF812Aug 27, 2025

  Based on observation, interview and record review the facility failed to maintain best practices in accordance with professional standards of food service safety. The deficient practice has the potential to result in food borne illness among all residents that consume food from the kitchen.Findings Include:On 8/25/25 at 9:36 AM, An interview with Dietary Manager D found that items in the kitchen are held for three days before being discarded. Observation of the three door True Cooler found a bag of shredded lettuce dated 8/18 to 8/20 with a best by date of 8/23. Further review of the unit found a box of Nutritional Mighty Shakes with no date to indicate discard, item states they are good 14 days from thaw. […]

• No harm, potential for more than minimal, widespreadF868Sep 13, 2024

  Based on interview and record review, the facility failed to ensure that Quality Assessment and Assurance (QAA) meetings were held at least quarterly and the required individuals attended the meetings resulting in the potential for quality deficiencies not being identified or corrected. Findings include: Review of the Quality Assurance and Performance Improvement (QAPI) meeting sign in sheets revealed that the facility had QAPI meetings on 10/20/2023, 12/21/2023, 1/25/2024 and 8/29/2024. The Medical Director did not attend the QAPI meeting on 1/25/2024 and on 8/29/2024. There were no QAPI meetings from 1/25/2024 to 8/29/2024. […]

• No harm, potential for more than minimal, widespreadF882Sep 13, 2024

  Based on interview and record review, the facility failed to ensure the Infection Preventionist (IP) completed specialized training in infection prevention and control, resulting in the potential for knowledge deficits pertaining to current infection prevention and control standards. Findings include: In an interview on 09/12/24 at 10:09 AM, Director of Nursing (DON) B reported that she was the facilities IP, and ran the infection control program for the facility, with the assistance of Unit Manager (UM) LL. DON B reported that she had completed all of the modules from the CDC (Center for Disease Control and Prevention) IP certification training program, but did not complete the post test. DON B reported that she did not have an IP certificate. […]