Vineyard Post Acute

In the surveyor’s words

From the most serious findings on record at Vineyard Post Acute, in the surveyor’s own words.

• Actual harm, patternF684Sep 5, 2023

  Based on interviews and records review, the facility failed to assess, monitor, and provide necessary care for one of two sampled residents (Resident 1) when: 1. The facility did not provide the necessary nursing assessment for Resident 1 ' s underlying cause of vomiting; did not provide prompt intervention to prevent Resident 1 from further vomiting when Resident 1 started vomiting in the morning of [DATE] and was given first dose of Ondansetron (a medicine used to prevent and treat nausea and vomiting) at 8:51 p.m.; and did not monitor Resident 1 for possible complications associated with vomiting, when Resident 1 vomited three times within a 12 hour period. 2. […]

• Actual harm, isolatedF678Feb 13, 2025

  Based on interview and record review, the facility staff failed to recognize a cardiorespiratory arrest (a life-threatening medical emergency that occurs when the heart and lungs stop functioning properly) for one of three sampled residents (Resident 1), which resulted in a delay in performing CPR (or cardiopulmonary resuscitation, a procedure to keep the blood pumping when the heart stops or when it beats too ineffectively to circulate blood to the brain and other vital organs) on Resident 1 who was a full-code (a medical directive indicating that a patient wishes to receive all possible life-saving measures in the event of a medical emergency) after he was found unresponsive. […]

• Actual harm, isolatedF687Nov 22, 2024

  Based on observation, interview and record review, the facility failed to ensure 1 of 2 sampled residents (Resident 1), who had a history of Diabetes Mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing) and amputation (surgical removal) of his right leg above the knee, received care consistent with nursing standards of practice and the resident's individualized care plan when: 1) Licensed nursing staff did not document daily skin assessments (to identify skin injury) for Resident 1, as indicated in his Nursing Care Plan (document that contains essential information about a patient's condition, diagnosis, goals, interventions, and outcomes); 2) Licensed nursing staff did not document the condition Resident 1's remaining foot (left) for a period… […]

• Actual harm, isolatedF622May 1, 2024

  Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) with metastatic breast cancer (The most advanced stage of breast cancer, which occurs when breast cancer cells spread from the breast to other organs) in moderate to severe pain, was discharged from the facility with her physician prescribed controlled opioid medications (Highly addictive non-synthetic medications whose use and distribution are tightly controlled by the government because of their abuse potential or risk) to manage her pain. […]

• No harm, potential for more than minimal, widespreadF814Dec 18, 2025

  Based on observation, interview, and record review, the facility failed to ensure garbage was properly contained when an outside garbage dumpster was overfilled, which prevented the lid from closing, and resulted in the food debris and trash surrounding the area and garbage can lids in the kitchen were not closed and the exterior surfaces were smeared with food debris.These failures decreased the facility's potential to prevent an infestation of insects and other pests, prevent offensive odors and contribute to cross-contamination from unsanitary environmental conditions.Findings:During a concurrent observation and interview in the garbage disposal area of the facility with the Dietary Manager (DM) on 12/15/25 at 8:50 a.m., several large garbage dumpsters were observed. […]