The Reserve Healthcare And Rehabilitation

In the surveyor’s words

From the most serious findings on record at The Reserve Healthcare And Rehabilitation, in the surveyor’s own words.

• Immediate jeopardy, widespreadF835Apr 13, 2023

  Based on review of facility policy, record review, and interviews, the facility failed to be administered in a manner that enabled it to use its financial resources effectively and efficiently. Specifically, the facility failed to have a system in place to ensure all financial obligations are met to guarantee care and services are provided to the residents. This failure has the potential to affect all 86 residents residing in the facility. On 04/13/23 at 1:31 PM the Administrator was notified that the failure to keep up to date with payment to vendors, utility services, and critical services provided to the residents of the facility constituted Immediate Jeopardy (IJ) at F835. The facility was unable to present an acceptable plan of removal of the immediate jeopardy. […]

• Immediate jeopardy, widespreadF837Apr 13, 2023

  Based on review of facility policy, record review, and interviews, the facility failed to have an effective governing body in place to ensure proper management and operation of the facility's financial resources. Specifically, the facility's governing body failed to have a system in place to ensure all financial obligations were met to guarantee care and services are provided to the residents. This failure had the potential to affect all 86 residents residing in the facility. On April 13, 2023, at 1:31 PM, the Administrator was provided with an Immediate Jeopardy (IJ) Template indicating IJ existed at F837 with a scope and severity level of L. The facility was unable to present an acceptable plan of removal of the immediate jeopardy. […]

• Immediate jeopardy, isolatedF689Jun 20, 2022

  Based on record reviews, staff interviews, and review of the facility policy, the facility failed to provide adequate supervision for 1 of 3 residents reviewed for accidents related to wandering. Resident (R)1 had a successful elopement on June 15, 2022, between 10:30 PM and 10:55 PM. Failure to establish, maintain and implement written policies and procedures regarding supervision places an individual's health and safety at risk for serious injury, harm, impairment, or death. On June 15, 2022, at approximately 10:30 PM, R1 was last seen on the 300 Unit attempting to exit the side door. Her wanderguard, located on her left ankle set the alarm off. As staff was responding, Certified Nursing Assistant (CNA)1 redirected R1 away from the door and down the hall. […]

• Immediate jeopardy, isolatedF600Jan 7, 2022

  Based on review of the facility's policy titled, Abuse, Neglect and Exploitation, record review, and interviews, the facility failed to ensure Resident (R)1 was free from abuse and/or neglect. Specifically, facility staff failed to prevent R1 from elopement from the facility on 1/4/22 at 4:30 AM. The facility's failure constituted substandard quality of care. R1 exited the rear exit door of the 200 Hall (COVID quarantine unit) on 1/4/22 at approximately 4:30 AM. During the time outside the facility (estimated to be 30-45 minutes), R1 walked out the back entrance of the 200 Hall (COVID quarantine unit) on 1/4/22 around 4:30 AM and was wearing a wander guard that did not alarm with an assortment of clothes with no jacket or shoes. […]

• Immediate jeopardy, isolatedF689Jan 7, 2022

  Based on review of the medical record and interviews, the facility failed to ensure Resident (R)1 was free from accident hazards related to wandering/elopement. Specifically, facility staff failed to prevent R1 from elopement from the facility on 1/4/22 at 4:30 AM. The facility's failure constituted substandard quality of care. R1 exited the rear exit door of the 200 Hall (COVID quarantine unit) on 1/4/22 at approximately 4:30 AM. During the time outside the facility (estimated to be 30-45 minutes), R1 walked out the back entrance of the 200 Hall (COVID quarantine unit) on 1/4/22 around 4:30 AM and was wearing a wander guard that did not alarm with an assortment of clothes with no jacket or shoes. […]