Willowbrooke Court Skilled Care Center - Edgewater

In the surveyor’s words

From the most serious findings on record at Willowbrooke Court Skilled Care Center - Edgewater, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF804Dec 14, 2023

  Based on observation, interview and record review, the facility failed to follow standardized recipes to ensure that food was appetizing, palatable, and flavorful that could potentially affect any resident who may request Chicken Noodle soup with their meals. This practice could affect 18 out of 19 residents residing on the 3rd floor, certified section. The findings included: Review of the facility's Standardized Recipe for preparation and serving of Chicken Noodle Soup noted the following: 6-ounce Chicken Base 3 gallons Tap Water Chopped Celery, Onion, Carrots 1 lb. [pound] 8 ounces Cooked Pulled Chicken Meat Poultry Seasoning, Black Pepper 1 Pound Dry Egg noodles Combine water, base vegetables, spices and chicken to a boil. Simmer 30 min [minutes]. […]

• No harm, potential for more than minimal, widespreadF812Dec 14, 2023

  Based on observation, record review and interview, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety potentially for 18 out of 19 residents residing on the 3rd floor, certified section. The findings included: Review of the facility's Culinary Services Manual - Policies and Procedures: Cleaning and Sanitation Issued: ,d+[DATE], Revised: ,d+[DATE], documented, in part, the following: Procedure: (b) The Culinary and Nutrition Services management team is responsible for developing written daily cleaning schedules. (c) The manager initiates the cleaning schedule and supervises employee comp, to the schedule. (d) All cleaning tasks will be checked nightly to ensure the meet ACTS standards. […]

• No harm, potential for more than minimal, isolatedF758Aug 4, 2022

  Based on interviews, record and policy review, the facility failed to ensure that antipsychotic medication had a clinical indication for use, that the ordering Prescriber had conducted a comprehensive assessment of the resident and that behaviours were adequately monitored for 1 of 5 sampled residents reviewed for the unnecessary medication (Resident #46). The findings included: A review of the facility's policy, titled, [CONDITION(S)] Medication Use, dated 12/01/2007, showed that the following: all medications used to treat behaviors must have a clinical indication and be used in the lowest possible dose and should be monitored for efficacy, risks, and benefits. […]

• No harm, potential for more than minimal, isolatedF761Aug 4, 2022

  Based on observation, interview, record review of policy & procedure review, the facility failed to properly dispose of a remaining powder medication packet for 1 of 6 sampled residents observed during a Medication Administration Observation, Resident #149; failed to ensure it maintained the resident's medication in line of sight, during a Medication Administration Observation, for 1 of 6 sampled residents observed, Resident #149; failed to properly dispose of an unsecured, expired over-the-counter (OTC) medication at the resident's bedside for 1 of 13 residents observed during an observational tour, Resident #17; and failed to ensure it properly secured medication as a 'loose' pill was observed on the dining room patio floor during a facility residents' activity. […]

• No harm, potential for more than minimal, isolatedF689Jul 6, 2022

  Based on interview, record review and observation the facility failed to prevent 1 of 1 sampled residents reviewed for elopement, Resident #1, from exiting the facility to outside of the facility unsupervised. The findings included: The facility's Policy and Procedures Manual has a subject titled Elopement/Wandering Risk Assessment, issued 04/03 and last revised 03/21, that defines Elopement as When a cognitively impaired resident leaves the community without following the community policies and procedures for signing out. […]