Transitional Care Services at Mercy Medical Center

In the surveyor’s words

From the most serious findings on record at Transitional Care Services at Mercy Medical Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF578Nov 21, 2025

  Based on medical record review and staff interviews, it was determined that the facility failed to ensure the resident/responsible party was offered the opportunity to develop an advance directive for 4 (#18, #2, #12, #13) of 4 sampled residents for advance directives during the annual survey. The findings include:An advance directive is a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. […]

• No harm, potential for more than minimal, patternF657Apr 2, 2024

  Based on observation, medical record review, and interview, it was determined the facility staff failed to: 1) review and revise resident care plans to reflect accurate and current interventions, and 2) ensure the full interdisciplinary team including residents and/or their responsible parties were invited to the care plan meetings and 3) have care plan meetings for residents who had been in the facility 21 days or more. This was evident for 4 (#4, #12, #13, #15) of 27 residents reviewed during a recertification survey. The findings include: A care plan is a guide that addresses the unique needs of each resident. It is used to plan, assess, and evaluate the effectiveness of the resident's care. Tube feeding is a way of getting your body the nutrition it needs. […]

• No harm, potential for more than minimal, isolatedF641Nov 21, 2025

  Based on medical record review and staff interview, it was determined the facility staff failed to ensure Minimum Data Set (MDS) assessments were accurately coded. This was evident for 2 (Residents #12, #9) of 4 residents reviewed for nutrition during the annual survey. The findings include: The MDS is part of the Resident Assessment Instrument that was Federally mandated in legislation passed in 1986. The MDS is a set of assessment screening items employed as part of a standardized, reproducible, and comprehensive assessment process that ensures each resident's individual needs are identified, that care is planned based on those individualized needs, and that the care is provided as planned to meet the needs of each resident. […]

• No harm, potential for more than minimal, isolatedF655Nov 21, 2025

  Based on medical record review and staff interview it was determined that the facility staff failed to ensure a resident had a baseline care plan created and initiated within 48 hours of admission to the facility. This was evident for 1 (Resident #12) out of 12 residents reviewed during the annual survey. The findings are:The baseline care plan is given to residents within 48 hours of their admission and details a variety of components of the care that the facility intends to provide to that resident. In addition to the baseline care plan, residents are also expected to receive a list of their admission medications. […]

• No harm, potential for more than minimal, isolatedF692Nov 21, 2025

  Based on medical record review and interview, the facility staff failed to thoroughly assess and monitor residents at risk for weight loss. This was evident for 3 (Resident #9, #36, #12) of 4 residents reviewed for nutrition during an annual survey.The findings include: 1) Review of Resident #9's medical record on 11/19/25 revealed the Resident was admitted to the facility on [DATE] and the facility staff documented the Resident's weight to be 169 pounds. Further review of Resident #9's medical record revealed the Resident was assessed by Dietitian #1 on 11/4/25 and documented the Resident had Nutrition Diagnosis #1 Moderate acute disease or injury related to malnutrition and Nutrition Diagnosis #2 Inadequate oral intake. […]