**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility billing records, emails, invoices and past due notices, review of bank statements, review of the facility assessment, Nursing Home admission Agreement, facility policy and procedures, and interviews with residents/family, staff, vendors, and company personnel, the facility neglected to meet financial obligations for the delivery of care and maintenance and to operate in a manner to ensure all bills were being paid in a timely manner to prevent the actual and potential interruption in services and to meet the total care needs of all residents admitted to and/or retained in the facility. This resulted in Immediate Jeopardy on 04/01/24 when the identified lack of financial solvency placed all facility residents at risk for serious harm, injury, hospitalization, displacement due to the actual and potential interruption in utility and/or outside service providers. Financial concerns were identified and included, but were not limited to delinquent balances owed to the water company resulting in a shut off notice issued 04/01/24 with water services to end 04/12/24, delinquent balances owed to the phone leasing company resulting in phone service interruption on 04/01/24, delinquent balances owed to the facility current food vendor which resulted in food delivery being placed on hold on 04/02/24, and delinquent balances owed to the contracted therapy provider resulting in therapy services terminating on 04/05/24. This had the potential to affect all 56 residents residing in the facility. On 04/02/24 at 2:47 P.M., the Administrator, Director of Nursing (DON) and Chief Executive Officer (CEO) #805 were notified Immediate Jeopardy began on 04/01/24 when an onsite investigation determined the facility neglected to meet all financial obligations for the delivery of care and maintenance of the facility by not paying vendors in a timely manner to prevent actual and potential interruption in services and to meet the total care needs of residents. The Immediate Jeopardy remains ongoing as of 04/15/24 as the facility failed to provide evidence of an effective abatement plan. Findings include: On 03/22/24 at 2:50 P.M. confidential information provided to the State agency revealed ongoing financial solvency concerns in the facility and that the facility was not paying their vendors. The concerns included therapy services being on hold for residents due to non-payment, the facility running out of food for residents, having little to no resident care supplies (including incontinence briefs) and that the facility phones were set to be turned off due to non-payment. Additional confidential concerns provided to the State agency included concerns the facility had been in financial trouble for almost a year due to the inability to pay vendors. The source of the concern indicated the facility would change vendors, with a specific example given of the facility food vendor, who after owing upwards of $60,000-$70,000 to the previous company and not being able to pay them, the facility simply switched to a new vendor. The source indicated there were some utilities/vendors who required cash payment as they would no longer take a check or electronic payment from the facility. The source also shared he/she had witnessed vendors come into the facility and sit until they received payment, because the facility was so far behind on payments. Lastly the source indicated the facility was utilizing agency staffing to fill 99% of their shifts and had not had a Director of Nursing or Minimum Data Set (MDS) nurse for some time. On 03/26/24 at 7:38 A.M. an interview with the Administrator revealed she began her employment with the facility on 03/20/23. During the interview she indicated she did not handle any financial aspects of the facility. The Administrator indicated the facility was a non-profit facility with a Board of Directors and Chief Executive Officer (CEO) #805 was responsible for the financial aspect of the facility including paying vendors. On 03/27/24 at 12:38 P.M. interview with CEO #805 revealed the facility had payment issues due to a low census and low funds and were now just catching up on their payments. On 03/27/24 at 1:44 P.M. a telephone interview with Business Office Manager (BOM) #831 revealed during routine audits she noted the facility was unable to process payments for resident care and the facility bills were not paid timely (date(s) not provided). BOM #831 indicating she reported these concerns to CEO #805 (date(s) not provided). On 04/01/24 at 1:41 P.M. an interview with the Medical Director revealed he was not aware of the facility being behind on payments. The Medical Director revealed he was unaware of residents not having enough supplies, food, medications, or not receiving resident care. The Medical Director revealed he attended a quarterly Quality Assurance/Performance Improvement (QAPI) meeting the week prior and the facility did not bring up any issues with the inability to pay vendors. The Medical Director then stated he was not involved in the financial side of the facility. On 04/01/24 at 4:06 P.M. an interview with CEO #805 revealed the facility had a cash flow issue due to changes in management. CEO #805 indicated their Minimum Data Set (MDS) employee, MDS #826 quit recently on 02/25/24 and the previous BOM, BOM #870 quit 12/29/23, and the facility had a difficult time finding replacements. CEO #805 stated resident MDS 3.0 comprehensive assessments were not being completed on time and the facility was not generating payments for resident care due to late MDS assessments. He denied the facility initiated or developed any type of QAPI plan to resolve the identified financial issues, to ensure vendors were paid in a timely manner to prevent potential or actual interruption in services and to meet the total care needs of all residents admitted to and/or retained in the facility. CEO #805 stated the facility had three options, keep going like they were, find new staff to timely complete resident care and billing or shut down the facility. Review of the Deposit Accounts bank statement dated 04/01/24 revealed the skilled nursing facility had a current balance in its general fund operations account of $6,971.18. On 04/02/24 at 2:29 P.M. an interview with the Administrator revealed she was resigning her position as administrator at the facility effective 04/22/24. The Administrator also revealed Rehab Director #824 had recently resigned his position due to the instability of the facility. On 04/03/24 at 11:16 A.M. interview with CEO #805 revealed he realized late on 04/02/24 Business Office Manager (BOM) #831 was not completing her duties as required and had not sent out billing in a timely manner for the months of 01/2024 and 02/2024. CEO #805 then stated this was the reason the facility had cash flow issues. There was no evidence this had been identified by the facility as a potential reason for cash flow issues prior to 04/02/24 during the onsite survey investigation. On 04/03/24 at 11:38 A.M. an interview with the Administrator and the Director of Nursing (DON) revealed CEO #805 talked to all staff on 04/02/24 during the evening shift and told them the State agency had identified monetary concerns. The Administrator and DON revealed they felt the CEO created increased anxiety and panic with the staff because of his communication and even stated to staff that all of the facility bank accounts were frozen. On 04/03/24 at 12:08 P.M. an interview with Board Member #866 revealed the most recent board meeting was held on 03/21/24 which was an executive session due to an employee grievance. The meeting prior to this was held on 03/13/24 which himself, CEO #805, Board Member #867 and Board Member #868 were in attendance for. He stated during this meeting, the financial side of the building was discussed. He stated he was aware several vendors were not getting paid timely but stated he was not aware of any disconnection notices. Board Member #866 revealed it was his understanding CEO #805 worked out payment arrangements with the vendors including the food vendor. He stated he was aware therapy services discontinued their service and was also aware that the phones were not working. Board Member #866 revealed Plan B regarding the phones was arranged to include changing phone providers. No additional information was provided as to why the plan did not include paying the current phone service. He stated he comes to some of the facility QAPI meetings, but not all of them. He stated the boards stance on the facility money issues included trying to get a loan on the property or selling some of the property to an interested buyer. On 04/11/24 at 11:16 A.M. an interview with the Administrator revealed beginning over the previous two months she had increased concerns related to her ability to effectively function as the administrator in the facility due to conflict that was occurring with CEO #805. The Administrator indicated there had been some concerns during the entire time of her employment that had escalated during the recent months and included concerns the CEO was not providing effective leadership or managing the facility finances properly. As of 04/01/24, during an on-site investigation, the facility and/or vendors provided information of outstanding balances included but were not limited to the following: Balances of $2205.00 and $2,632.50 owed to Registered Dietitian (RD) #829, a balance of $2,099.71 for Supply Vendor #853, a balance of $56,348.62 for Staffing Vendor #854, a balance of $23,795.48 for Pharmacy Collections #842, a balance of $7,028.43 for Medical Supply #859, a balance of $10,132.04 for Supply Vendor #860, a balance of $12,722.19 for Food Vendor #858, a balance of $40,259.27 for Food Vendor #852, a balance of $11,091.80 for Information Technologies (IT) #843, a balance of $55,180.95 for Therapy #847, a balance of $3,170.00 for Phone #848, a balance of $33,278.93 for Supply Vendor #857, a balance of $1,175.74 for Monitoring Vendor #861, a balance of approximately $5,200.00 to Oxygen Vendor #862 and a balance of $5,642.97 to Water/Sewer Vendor #863. These balances totaled $271,963.63. a. Review of the master therapy list revealed 20 residents were currently on therapy caseload/services including Resident #3, #4, #6, #7, #8, #12, #13, #14, #19, #20, #23, #26, #30, #37, #44, #51, #55, #106, #107 and #108. Review of an email from Therapy Credit Manager #847 from the facility contracted therapy department dated 03/28/24 at 1:53 P.M. revealed this vendor had not heard from anyone (from the facility) regarding payment or a plan to get current. On 04/01/24 at 1:50 P.M. an interview with Therapy Credit Manager #847 revealed the facility was outside their contracted terms due in part to money owed the therapy vendor. Therapy Credit Manager #847 revealed the facility had made a payment on 03/04/24 for $6,000 and an additional payment on 03/11/24 for $30,000. However, she stated the facility was supposed to make payments every thirty days and the facility was past due in the amount of $20,072.15 for 01/2024 and $35,108.80 for 02/2024 for a total of $55,180.95. On 04/03/24 at 2:25 P.M. interview with Physical Therapy Assistant (PTA) #869 revealed the contracted therapy vendor was terminating therapy services from the building on 04/05/24 due to lack of payment. On 04/04/24 at 11:31 A.M. an interview with Administrator revealed of the 20 residents on therapy, seven residents, Resident #6, #7, #8, #13, #106, #107 and #108 requested to be transferred or sent home due to lack of therapy services. On 04/10/24 at 9:24 A.M. a telephone interview with the Administrator revealed CEO #805 was in negotiations with another therapy company to provide therapy services. No additional information was provided related to the status of the residents affected by the termination of therapy provider and their therapy needs between 04/06/24 and 04/10/24. Interview on 04/11/24 at 9:40 A.M. with Resident #44 indicated she was ordered therapy services and was not getting it. Record review revealed the resident had been on therapy case load for speech therapy services for dysphagia. The resident's last documented therapy session was on 04/05/24. Interview on 04/11/24 at 9:35 A.M. with Resident #51 revealed she was not receiving therapy services and was getting rusty. Record review revealed the resident had been on therapy case load for physical therapy services for gait training. The resident's last documented therapy session was on 04/05/24. On 04/11/24 at 4:30 P.M. the Administrator provided information CEO #805 had met with a new therapy company for possible new merger/contract for services and new therapy director. However, the Administrator indicated the date for implementation was unknown as of this time. In addition, CEO #805 was unavailable to provide any additional information related to therapy services at of this time. On 04/12/24 at 11:30 A.M. the facility provided a list of residents, including Resident #6, #7, #8, #13, #106, #107 and #108 who had actually discharged from the facility between 04/05/24 and 04/09/24 per their request due to the lack of therapy services available in the facility. Resident #12 discharged home on [DATE] after completing therapy services on 04/05/24. On 04/15/24 at 10:22 A.M. during an interview with the DON, the DON revealed the facility had not contracted with a therapy company to provide therapy services to residents as of this date. On 04/15/24 at 11:10 A.M. an interview with the Administrator revealed CEO #805 informed her that a meeting with a therapy company was held on 04/12/24 but as of this date, services for therapy/contracted provider was not confirmed. On 04/15/24 at 12:52 P.M. during a follow-up interview with the Administrator, the Administrator indicated CEO #805 had replied to a text message she had sent him regarding therapy. The Administrator revealed CEO #805 indicated they would have a new therapy company within 10 days. The Administrator revealed CEO #805 did not provide the name/phone number of the new therapy service and stated she was not aware if there was an actual contract yet. b. On 04/02/24 at 1:52 P.M. a telephone interview with Water/Sewer Vendor #863 revealed the facility had a current balance of $8,868.78 which included a past due balance of $5,642.97. Water/Sewer Vendor #863 revealed the facility was issued a disconnect notice effective 04/12/24 if payment in the amount of at least $5,642.97 was not made. On 04/03/24 at 1:25 P.M. a follow up telephone interview with Water/Sewer Vendor #863 with CEO #805 and Licensed Practical Nurse (LPN) 701 (the Wellness Director for the Assisted Living) in attendance revealed the facility owed $8,868.78 with a past due balance of $5,642.97 which had to be paid by 04/12/24 or the water would be disconnected. The facility provided evidence of a payment made to the water company dated 04/03/24 (during the onsite survey). On 04/09/24 at 12:55 P.M. an additional follow up interview with Water/Sewer #877 confirmed a payment was made and the disconnection notice was removed from the account (based on the payment). c. Review of an email from Staffing Vendor #854 dated 03/18/24 at 8:54 P.M. indicated the staffing vendor attempted to reach the facility by phone on 03/18/24 without success. The email included the facility account would be pending on 03/20/24 due to non-payment. The email instructed the facility to please provide a payment update on the identified invoice by 03/19/24 to prevent the account from being pended. An amount of $35,551.18 was now past due with $20,797.44 due 03/19/24 for a total past due balance in the amount of $56,348.62. On 03/26/24 at 8:36 A.M. an interview with Scheduler #821 revealed the facility required the use of agency nursing staff to adequately staff all shifts in the facility. However, if this current staffing agency used by the facility would discontinue providing staff as of 04/01/24 they would not have enough nurses to cover all shifts. Scheduler #821 also revealed the facility did not have sufficient staff to cover a shift if one of their regular staff members called off. On 03/26/24 at 9:45 A.M. an interview with CEO #805 verified the facility did not have enough facility employed nurses to cover all open shifts. CEO #805 confirmed the facility had used nurses from a staffing agency to fill these shifts. On 04/01/24 at 9:07 A.M. a telephone interview with Staffing Agency #837 revealed the facility owed a total of $116,924.69 to this staffing agency and no payment arrangements had been made as of this date. Staffing Agency #837 revealed the facility account had been suspended as of 03/27/24 due to non-payment and no agency staff would be provided to the facility moving forward. On 04/01/24 an interview beginning at 10:35 A.M. with Scheduler #821 indicated the facility started using staffing agency in 06/2023 and the facility had previously used five different staffing agencies that were all terminated/discontinued due to nonpayment. Scheduler #821 indicated the current staffing agencies (noted above) would no longer send staff because of a delay in or lack of payments. Scheduler #821 revealed for the April 2024 schedule there were 49 open shifts that did not have nurse scheduled due to the lack of facility employed staff and/or the inability to use agency staffing. On 04/01/24 at 10:35 A.M. review of the facility staffing schedules with Scheduler #821 verified the 49 unfilled nursing shifts from 04/01/24 to 04/30/24 in which there was no nurse scheduled for the shift. This included seven shifts from 04/01/24 to 04/06/24 which the Director of Nursing (DON) indicated the administrative staff would have to fill and they would take the staffing week by week. On 04/03/24 at 11:40 A.M. an interview with the DON revealed her last day in the facility was going to be 04/18/24 as she was an interim DON and had requested another assignment. During the interview the DON revealed as of this date, the facility did not have enough nursing staff to cover 04/06/24 or 04/07/24. The DON indicated she was going to try to call nursing staff to see if she could find coverage for the weekend. On 04/11/24 at 10:21 A.M. interview with the Interim DON revealed staff nurses had picked up the open shifts and/or worked over on 04/06/24 and 04/07/24. Review of the Facility Wide Assessment form dated 05/2018 and last updated 05/23/23 revealed the facility supplied resident support/care needs including activities of daily living, mobility and fall/fall with injury prevention, bowel/bladder, skin integrity, mental health and behavior services, medication administration, pain management, infection control and prevention, management of medical conditions, therapy services and nutrition services. Nurse management included a full-time DON, two full time unit managers, a full time MDS coordinator, a scheduling coordinator, three-day nurses, two-night nurses, seven STNA's for dayshift, seven STNA's for second shift and five STNA's for nightshift. The staffing also included a full-time Administrator, transportation director, registered dietitian, full time maintenance/housekeeping/laundry director, full time activities director, full time social services director, full time admissions/marketing director, full time billing office manager, full time human resources, full time therapy director and contracted medical director. d. Review of Food Vendor #858's (a previous food supplier) billing invoice dated 04/01/24 revealed the facility had a past due balance for a total amount of $12,722.19. The total past due balance included a past due amount of $931.02 for thirty days and $11,791.17 sixty days past due. Review of Food Vendor #852's (the current food supplier) invoice dated 04/01/24 from service of 12/12/23 through 03/29/24 revealed the facility owed a total of $95,098.80 which included $54,839.53 of the bill that was current and an additional $40,259.27 that was past due. On 04/01/24 at 10:53 A.M. telephone interview with Food Supplier #838 (for Food Vendor #852) with Dietary Kitchen Manager #830 in attendance verified a balance to Food Vendor #852 in the amount of $95,098.80 which included a past due amount of $40,259.47. Food Supplier #838 indicated the facility bill of $40,259.47 was greater than 60 days past due and the facility payments included $5,000 the week prior, a promised $10,000.00 on 04/08/24 and an additional promised $10,000.00 on 04/15/24. Food Supplier #838 indicated the vendor had requested the facility initiate a better payment plan to pay off the past due balance. On 04/01/24 at 10:47 A.M. an interview with Dietary Kitchen Manager #830 revealed the facility had difficulty paying vendors. Dietary Kitchen Manager #830 stated vendors had put their account on hold and they could not order general resident care supplies, she could not remember the exact dates but stated it was at some point in 01/2024 or 02/2024. On 04/01/24 at 10:55 A.M. interview with the Credit Management Staff (Food Supplier #851 and Food Supplier #838) associated with Food Vendor #852 with Dietary Kitchen Manager #830 in attendance revealed the last couple payments from the facility included a payment on 03/05/24 for $8,000.00 and a payment on 03/18/24 of $5,000.00. Credit Manager for Food Supplier #851 indicated a plan was requested to bring the payments current and the plan had not been addressed yet even though she tried to discuss the plan to bring the overdue invoices current with CEO #805. Credit Manager for Food Supplier #851 confirmed the facility began using them as a vendor for the second time around 09/2023. On 04/01/24 at 11:44 A.M. an interview with Kitchen Dietary Manager #830 revealed Credit Manager for Food Supplier #851 text her at this time and stated the vendor was considering holding the food order for the order date of 04/02/24 due to lack of payment. On 04/02/24 at 10:27 A.M. interview with Food Supplier #838 for Food Vendor #852 revealed she was physically in the facility to pick up a $10,000.00 check the facility was going to provide. She stated the food vendor decided to hold all future food orders until another $30,000.00 (total $40,000.00) was paid. She stated this would put the facility about sixty days past due and they would still owe another $65,000.00 to the vendor. She stated Dietary Kitchen Manager #830 reported the facility had approximately three weeks of food supplies available. On 04/02/24 at 11:14 A.M. interview with Dietary Kitchen Manager #830 revealed the facility would be able to follow the approved menu from the dietitian from 04/01/24 to 04/13/24 with the food they had on hand and without the food vendor delivering food. After that, she stated she would have to piece meal the meals by the available food supply. She indicated she was provided a facility credit card on this date to purchase fresh items including milk, eggs, and bread. During the interview, she shared she had resigned her position in the facility effective 05/01/24 but did not provide a reason why. On 04/03/24 at 1:41 P.M. a telephone interview with Food Supplier #838 and Credit Manager for Food Supplier #851 with CEO #805 in attendance revealed the facility agreed upon amount of payment of $10,000.00. Credit Manager for Food Supplier #851 stated they needed a plan to go forward of when the account would be made current and could not release a shipment of food until a concrete plan was put in place. Credit Manager for Food Supplier #851 stated their company could not allow the account to be over the 60-day term. On 04/09/24 at 10:03 A.M. an interview with Dietary Kitchen Manager #830 indicated she conducted an audit of food supplies on 04/02/24 and determined the facility actually had enough food to provide meals to residents per the menus or appropriate substitutions until 04/20/24. She stated after that time, she would have to piece meal the dinners with minimal food to pick from. Dietary Kitchen Manager #830 indicated she was provided a credit card to be able to go and buy fresh food supplies when needed (between this time and 04/20/24) with a $2500.00 limit. On 04/09/24 at 10:42 A.M. an interview with the Administrator indicated the facility was no longer going to use Food Vendor #852 and were reviewing options including Food Vendor #878 and Food Vendor #879 pending reviews on pricing, menu selection and delivery. On 04/10/24 at 4:23 P.M. information provided from the Administrator revealed the facility had decided to stay with Food Vendor #852 based upon a mutual agreement for delivery and payment (cash on delivery). The Administrator indicated delivery would resume next week. On 04/11/24 a tour of the facility kitchen revealed the facility had food available to serve meals as planned from 04/11/24 to 04/14/24. During the tour, Dietary Kitchen Manager #830 provided receipts for food purchases made, using the credit card she was issued on 04/05/24 and 04/09/24. On 04/05/24 $757.31 was spent and on 04/09/24 $1055.97 was spent for a total of $1813.28. On 04/11/24 at 7:59 A.M. interview with representatives from Food Vendor #852 with the Administrator present revealed they had spoken with CEO #805 on 04/10/24 to provide an offer on how to continue with their services as a food vendor. The CEO was informed the facility would need to pay by credit card, check or ACH with any order being cash on delivery (COD), plus a payment of $2500.00 per week to pay the outstanding back balance owed. The representative indicated the CEO stated he was still looking at other vendors and they (Food Vendor #852) would get paid at some point and he would let them know. The representative indicated CEO #805 then hung up on them. The representatives revealed there was no current order or delivery scheduled for the facility as of this date/time. On 04/11/24 at 10:07 A.M. and 11:16 A.M. interview with the Administrator revealed she was not part of the conversation between Food Vendor #852 and CEO #805 on 04/10/24 and was only reporting (on 04/10/24) to the State agency what she had been told (by CEO #805). The Administrator verified the facility did not have a current food vendor and indicated she had no authority to make decisions about this as it was being handled by CEO #805. The Administrator then shared that CEO #805 had since gone out of state, she was having trouble reaching him and did not know when he would return other than hearing rumor of him being back on 04/16/24. On 04/12/24 at 10:40 A.M. interview with the Administrator revealed the facility was in the process of resuming services with Food Vendor #858 (one of their previous food vendors who had terminated due to non-payment). However, as of this date there was no evidence a first payment had been made to the vendor (per the vendors request) or evidence of confirmation of an actual food delivery being scheduled. The Administrator revealed the facility was in the beginning phases of the process with securing Food Vendor #858. Dietary Kitchen Manager #830 revealed she had approximately $300.00 left on the credit card available to purchase food supplies as of this date/time. On 04/15/24 at 9:04 A.M. interview with Dietary Kitchen Manager #830 revealed she had been told by the Administrator that Food Vendor #858 was going to be the facility food vendor. Dietary Kitchen Manager #830 revealed she had been attempting to reach their food representative from this vendor since Friday with no success. She indicated CEO #805 was supposed to make payment and supposed to get an order, but stated she was unaware of what the status of this was as of this date/time. During the interview, Dietary Kitchen Manager #830 revealed the credit card she had been given to purchase food items with was no longer usable as it had been maxed out. On 04/15/24 at 9:11 A.M. a follow-up interview with Dietary Kitchen Manager #830 revealed she had spent $78.00 to purchase milk this morning (previous milk supply from 04/12/24). She was unable to use the credit card to purchase anything else as of this time. During this interview, Dietary Manager #830 revealed a dietary cook had submitted a resignation, effective 04/24/24. Dietary Manager #830 confirmed her last date of employment would be 05/01/24. On 04/15/24 at 10:08 A.M. observation of the freezer and dry storage area with Dietary Kitchen Manager #830 revealed for the lunch meal on 04/15/24, which was scheduled to be spaghetti and meatballs, the facility was substituting meatballs and cream sauce. On 04/15/24 at 12:32 P.M. an interview with Resident #29's son with Dietary Kitchen Manager #830 in attendance revealed he comes in daily to visit his mother and the mother had not been receiving her ice cream every meal since 04/11/24. He stated his mother practically lives off of ice cream and coffee and he was upset that she was private pay and he had to stop at the store to get ice cream for his mother. Interview on 04/15/24 at 12:36 P.M. with Dietary Kitchen Manager #830 indicated she was aware they were out of ice cream since 04/10/24 and Resident #29 did not receive ice cream as ordered. She stated she went this morning, and the credit card she had been given to purchase food (in the absence of a food vendor) would not work to buy ice cream because the credit card had reached it max limit. In addition, review of RD #829's billing statement dated 01/31/24 with a due date of 02/22/24 revealed 49 hours were billed for consultant dietitian services for 01/2024 in the amount of $2,205.00. The bill was unpaid as of 04/01/24. Review of RD #829's billing statement dated 02/26/24 with a due date of 03/22/24 revealed the facility owed 58.5 hours of consultant dietitian services for 02/24 in the amount of $2,632.50. The bill was unpaid as of 04/01/24. On 04/01/24 at 11:09 A.M. interview with RD #829 with Kitchen Dietary Manager #830 in attendance indicated she had not been paid by the facility for 01/2024 and 02/2024 for a total amount due of $4,630.00 which was due on 03/21/24. She indicated she provides the facility a 21-day grace period and sometimes it takes 45 days or 60 days for a payment, but she stated she does eventually receive payment. She stated she never knew when she would get paid. e. On 04/01/24 at 9:30 A.M. an attempt to contact the facility by telephone was unsuccessful. The call could not be completed as dialed. Interviews with staff during the investigation verified the facility phone system was not currently working and they could not receive incoming calls or make outgoing calls using the facility phone system. The staff interviewed revealed they had to use their own personal cell phones to make calls, including calls to physicians. On 04/01/24 at 2:18 P.M. telephone interview with Phone Representative #848 revealed telephone service in the building had been initiated in May 2022 and was not working on this date due to a technical issue. Phone Representative #848 revealed the facility had an outstanding current balance owed of $3,170.00 for the rental of telephone equipment and this balance would have to be paid before the company would come out to service the phones. Phone Representative #848 revealed the facility broke their 5-year contract (end date 04/01/27) due to non-payment and now the full amount due must be paid in the amount of $31,700.00 to resume services. On 04/01/24 from 2:43 P.M. to 3:00 P.M. interviews with Resident #15, #23, #24, and #52 revealed they used the facility phone to contact their family members. Review of the Telephone Rental bill dated 04/02/24 revealed the facility owed $3,170.00 due on 03/01/24 and total amount owed as of 04/01/24 was $31,700.00. On 04/02/24 at 12:20 P.M., an interview with the Administrator and the DON revealed the facility had begun receiving emails from family, vendors and dialysis centers regardi[TRUNCATED]