Village Shalom Inc

In the surveyor’s words

From the most serious findings on record at Village Shalom Inc, in the surveyor’s own words.

• Actual harm, isolatedF686Oct 19, 2023

  The facility had a census of 66 residents. The sample included 18 residents, with six reviewed for pressure ulcer (localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction). Based on observation, record review, and interview, the facility failed to implement preventative measure to prevent facility acquired pressure ulcers for three sampled residents. As a result, Resident (R) 26 developed facility acquired deep tissue injuries (DTI-localized areas of tissue damage of necrosis that develop because of pressure) to his right heel and his right and left outer malleolus (a bony projection on either side of the ankle), a Stage 2 (partial-thickness skin loss into but no deeper than the… […]

• Actual harm, isolatedF689Oct 19, 2023

  The facility had a census of 66 residents. The sample included 18 residents, with five reviewed for accidents. Based on observation, record review, and interview, the facility failed to provide supervision for one sampled resident, Resident (R) 31, who fell in the facility courtyard and fractured (broken) her right arm and right middle finger. The facility further failed to ensure a safe environment for R50, who fell in his room and fractured his nasal bone, fractured his lumbar transverse process (the bony projection on either side of your spine), sustained a laceration (cut) to his left eye, and bruising to his right side. […]

• No harm, potential for more than minimal, widespreadF812Jun 4, 2025

  The facility identified a census of 64 residents. The facility had one main kitchen, three kitchenettes, and dining areas. Based on observation and interview the facility failed to ensure that opened packages of frozen foods were stored in a sealed bag with a label and an open date. The facility failed to ensure staff wore a hairnet when in the kitchen food preparation and serving areas. The facility failed to ensure staff delivered plates of food in a sanitary manner. The facility failed to ensure staff performed hand hygiene after serving residents their plates and or drinks. […]

• No harm, potential for more than minimal, widespreadF851Oct 19, 2023

  The facility had a census of 66 residents. Based on interview and record review, the facility failed to submit accurate staffing information through Payroll Based Journaling (PBJ) to the Centers for Medicare and Medicaid Services (CMS). This deficient practice placed the residents at risk for unidentified and ongoing inadequate nurse staffing. Findings included: - Review of the facility's submission of payroll data to CMS revealed no data had been submitted as required by CMS for Fiscal Year (FY) 2022 Quarter 4. On 10/19/23 at 11:41 AM, Administrative Staff A provided email information related to the PBJ submission for quarter 4 that the information was submitted with errors. […]

• No harm, potential for more than minimal, widespreadF882Oct 19, 2023

  The facility had a census of 66 residents. The sample included 18 residents. Based on interview and record review, the facility failed to ensure the staff person designated as the Infection Preventionist (IP) possessed the qualifying education, training, experience as well as certification required to fulfill the role, placing the residents at risk of unidentified and untreated infections. Findings included: - On the survey form Department Heads filled out by the facility, the facility identified the IP as Certified Medication Aide (CMA) R. On 10/18/23 at 11:08 AM, Certified Medication Aide (CMA) R identified self as the facility IP. […]