Based on record review and interview it was determined that for one (R11) out of five residents reviewed for unnecessary medications, the facility failed to limit an as needed (PRN) psychotropic medication to 14 days. Findings include: Review of R11's medical record revealed: 2/14/23 - R11 was admitted to the facility. 1/2/24 - R11 had a Physician's order for clonazepam tablet 0.5 mg give 1 tablet by mouth PRN (as needed), two times a day for agitation and anxiety. There was no end date to the order. 1/22/24 8:58 AM - During an interview, E5 (LPN) stated that the doctor would look back at the behaviors that we document and put in a new order for PRN psychotropic medications. 1/22/24 9:17 AM - During an interview, E3 (ADON) confirmed the current order for the clonazepam did not have a stop date since it was ordered on 1/2/24 and that there was no evidence of an evaluation to extend the use of clonazepam for more than 14 days. 1/22/24 9:55 AM - During an interview, E4 (MD) stated the the of for the medication for 14 days then re-evaluate and if effective, then reorder it. E4 confirmed the clonazepam ordered on 1/2/24 did not have a stop date and did not have any documentation to continue the medication after the 14 day period. The facility failed to provide evidence that R11 was reassessed by the Physician for the need to extend the use of clonazepam for more than 14 days. 1/22/24 at 1:00 PM - Findings were reviewed with E1 (NHA), E2 (DON) and E3 (ADON) at the exit conference.

Based on observation and interview it was determined that the facility failed to ensure that food was properly stored, prepared and served in a manner that protects residents from foodborne illness and food contact surfaces are maintained in a sanitary condition. Findings include: 1/18/24 12:15 PM- During a tour of the kitchen, the surveyor observed E6 (District Dining Manager) test the sanitizer level of the solution in three red sanitizing buckets. When E6 tested the sanitizing solution, the test strips from two out of three buckets indicated that the level of chemical concentration in the buckets was not at a sufficient level to provide proper sanitization. 1/18/24 2:43 PM- During a review of the food temperature logs, the surveyor observed the facility kitchen records had no food temperatures recorded for fifty-eight (58) meals out of two-hundred thirty-four (234) meals sampled. Temperatures of cooked foods and cold ready to eat foods were not being consistently recorded prior to being served. Fish, meat and poultry must be heated to an appropriate specific temperature depending on the type of food and the method used to prepare it. Vegetables must be heated to one hundred thirty-five (135) degrees Fahrenheit (F), and cold ready to eat foods must be held below forty-one (41) degrees (F) to maintain food safety. 1/18/24 3:24 PM - Findings were confirmed with E1 (NHA) 1/22/24 at 1:00 PM - Findings were reviewed with E1 (NHA), E2 (DON) and E3 (ADON) at the exit conference.

Based on observation, interview and record review, it was determined that for one (R3) out of one resident(s) sampled for accommodation of needs, the facility failed to ensure that R3's call bell was within reach. Findings include: The following observations were made of R3: 3/18/21 - Record review indicated that R3 was admitted to the facility with a history of a stroke with left sided weakness. 10/18/22 - A quarterly MDS assessment documented that R3 was cognitively intact and required assistance for transfers. 12/19/22 10:03 AM - E9 (CNA) knocked on the door and asked R3 if he was ready to get up. 12/19/22 10:46 AM - R3 was sitting up in his recliner with the call bell hanging off the end of the bed out of reach. 12/19/22 10:56 AM - The call light remained hanging off the end of R3's bed. 12/19/22 1:10 PM - An interview with E9 (CNA) confirmed R3's call bell was not in reach after morning care stating, It slipped my mind, I usually give it to him, oh I'm sorry, I forgot. 12/22/22 10:41 AM - E10 (CNA) was observed leaving the room after R3 was up in the recliner and the call bell was not in reach. The call bell was attached to the left side of the bed. The Surveyor informed E10 that R3's call bell was not in reach and E10 confirmed and stated, I forgot. Findings were reviewed with E1 (NHA), E2 (DON) and E3 (ADON) at the exit conference on 12/22/22 at 3:39 PM.

Based on observation, interview and record review, it was determined that for one (R3) out of one resident reviewed for positioning, the facility failed to ensure that appropriate treatment and services were provided to maintain and/or increase range of motion. Findings include: The following was reviewed in R3's clinical record: 3/18/21 - R3 was admitted to the facility with a history of a stroke with left sided weakness. 1/26/22 - A Quarterly Occupational Therapy screen for services documented there were no changes and therapy services were not indicated at this time for R3. 2/21/22 - Record review of Rehab functional status form documented that R3 was to receive PROM (passive range of motion) to the left upper extremity, AAROM (active assisted range of motion) to the left lower extremity, and AROM (active range of motion) to the right upper and lower extremity for 15 minutes one time a day and signed by nursing. 2/22/22 - A physicians order written for R3 included PROM to the left upper extremity, AAROM to the left lower extremity and AROM to the right upper and lower extremity for 15 minutes one time a day. 4/13/22 - A physicians order documented that a left palm protector was to be applied in the morning after AM care check for signs for ill fit every shift. Remove after PM care or as per resident request patient may remove ad-lib. 10/18/22 - A quarterly MDS assessment documented R3 as having upper and lower impairment to his left upper arm and left hand. 12/19/22 10:46 AM - R3's left hand was observed to be contracted and R3 was not wearing a palm protector. 12/19/22 11:56 AM - R3's left hand was observed resting on his lap and R3 was not wearing palm protector. 12/20/22 1:50 PM - During an interview, R3 revealed, Nobody comes in to do any exercise to my hand. 12/20/22 1:25 PM - During an interview, E9 (CNA) stated, Usually the ROM is getting done when I'm getting him up to go to the bathroom and with his bathing he likes to get washed up in the bathroom, I raise his left arm up to put his shirt on and move his legs to put his pants on. 12/20/22 2:00 PM - During an interview, E7 (Physical Therapy Aide) stated CNA typically does the range of motion. 12.20/22 3:04 PM - During interview, E4 (Certified Unit Manager) stated the nurse signs off that the range of motion is being done. E4 showed the Surveyor where the nurse signs off that the range of motion, was done December 7 through December 20, 2022. 12/21/22 3:45 PM - During an interview, E8 (RN) stated, I don't guide the CNA in how to do range of motion, they have already been educated on how to do it and I can't say how long the range of motion is being done because I don't watch them, but I know it's being done because I know my staff. 12/22/22 9:59 AM - During interview, the Surveyor asked E10 how she does his range of motion E10 (CNA) stated, He has his own way of doing things, he doesn't want you to do a lot for him, but I lift his legs and put a rolled-up washcloth in his left hand. The interviews identified that staff were considering delivering care, including dressing, bathing and toileting to be ROM. There was no evidence that R3 was receiving 15 minutes of ROM (exercise) daily as prescribed. Findings were reviewed with E1 (NHA), E2 (DON) and E3 (ADON) at the exit conference on 12/22/22 at 3:39 PM.