**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual review, medical record review, observations, and interviews, the facility failed to accurately complete an MDS assessment for 1 resident (Resident #76) of 18 residents reviewed for MDS assessments. The findings include: Review of the MDS 3.0 RAI Manual dated 10/2024, revealed .discharge assessment .must be completed when the resident is discharged from the facility .SECTION A .discharge status .this item documents the location to which the resident is being discharged at the time of discharge .steps for assessment .review the medical record including the discharge plan and discharge orders for documentation of discharge location .coding instructions for A0310G .Code 1 if type of discharge is a planned discharge .Code 2 if type of discharge is an unplanned discharge . Review of the medical record revealed Resident #76 was admitted to the facility on [DATE] with diagnoses including Dementia, Peripheral Vascular Disease, and Delusional Disorder. Review of the comprehensive care plan for Resident #76 dated 2/6/2025, revealed .discharge plan .wishes to return home/ALF [Assisted Living Facility] . Review of a Progress Note for Resident #76 dated 2/6/2025, revealed .previously lived at .ALF, and family is seeking .with alternate ALF placement .begin d/c [discharge] planning . Review of a Progress Note for Resident #76 dated 2/28/2025, revealed .Spoke with resident's son .r/t [related to] d/c to ALF .Son stated he planned to take resident to .ALF on Tuesday 3/4/25 . Review of a Progress Note for Resident #76 dated 3/4/2025, revealed .Discharge Summary .Resident discharged from facility to go to ALF with her son .in personal vehicle . Review of a Discharge Return Not Anticipated MDS assessment dated [DATE], revealed Resident #76 was coded as an unplanned discharge. During an interview on 5/29/2025 at 1:05 PM, with Registered Nurse (RN - D) confirmed the MDS assessment dated [DATE] was coded inaccurately as unplanned discharge. RN D confirmed that Resident #76's discharge from facility had been a planned discharge. During an interview on 5/29/2025 at 3:30 PM, the Director of Nursing confirmed Resident #76's MDS assessment dated [DATE] had been coded inaccurately.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observation, and interview the facility failed to revise the care plan for 1 resident (Resident #68 ) of 18 residents reviewed for care plans. The findings include: Review of the facility 's policy titled, Person Centered Care Planning, dated 9/5/2024, revealed .The facility .develops a person-centered care plan that addresses the goals, preferences, needs and strengths of the resident, including those identified in the comprehensive resident assessment .to attain or maintain .highest practicable well-being and prevent further decline .to meet those needs .developed and implemented to ensure consistency .across all shifts . Review of the medical record revealed Resident #68 was admitted to the facility on [DATE] with diagnoses including Alzheimer's Dementia with Behavioral Disturbance, and Hallucinations. Review of the comprehensive care plan for Resident #68 dated 5/14/2025, revealed .EATING: The resident is able to feed self after tray set up with encouragement from staff & minimal assistance . Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #68 scored 0 on the Brief Interview for Mental Status (BIMS) assessment which indicated severe cognitive impairment. Further review revealed the resident was dependent upon staff with eating. During an interview on 5/27/2025 at 11:45 AM, Certified Nursing Assistant (CNA) B stated Resident #68 was dependent upon staff with eating. During an interview on 5/29/2025 at 9:35 AM, CNA A stated Resident #68 was dependent upon staff with eating. During an interview on 5/29/2025 at 9:40 AM, Certified Occupational Therapy Assistant (COTA) C stated she worked with Resident #68 on self-feeding and the resident was not able to perform the activity on her own due to her cognitive decline. During an observation on 5/29/2025 at 12:28 PM, revealed CNA A set up Resident #68's meal tray and began assisting the resident with the meal. During an interview on 5/29/2025 at 1:05 PM, with Registered Nurse (RN) D and the RN MDS Coordinator revealed Resident #68's care plan had not been revised to reflect the resident was dependent on staff with eating. During an interview on 5/29/2025 at 3:35 PM, the Director of Nursing stated Resident #68's care plan had not been revised to show the resident had total dependence upon staff with eating.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, observation, and interview, the facility failed to follow the facility's policy and meet safety and sanitation requirements for food items stored in 2 residents' personal refrigerators (Resident #13 and Resident #37) of 6 residents' personal refrigerators observed. The findings include: Review of the facility's policy titled, Resident Refrigerators, with a revised date of 4/30/2025, revealed .Facility staff will check individual food items weekly for expiration dates .food will be labeled and dated to monitor for food safety .Food items in unmarked or unlabeled containers should be labeled with contents, and the date the food item was stored .food .with visible signs of contamination should be discarded immediately . During the initial tour of the facility on 5/27/2025, from 9:10 AM - 1:00 PM, Residents' #13 and Resident #37 were noted to have personal refrigerators in their rooms. Medical record review revealed Resident #13 was admitted to the facility on [DATE] with diagnoses including Type 2 Diabetes, Chronic Kidney Disease, Anxiety Disorder, and Depression. During an observation on 5/29/2025 at 10:48 AM, in Resident #13's room revealed the resident's room contained a personal refrigerator. Contents in the refrigerator contained a plastic container which held sliced tomatoes. The container was unlabeled and undated. Upon opening the container, the tomatoes were covered by a white film and a foul odor was present. Continued observation revealed a clear glass jar with a blue metal lid which was not labeled or dated. The contents of the jar contained a dark pink liquid, eggs without their shell, and brown square cubes. Medical record review revealed Resident #37 was admitted to the facility on [DATE] with diagnoses including Chronic Respiratory Failure, Anxiety Disorder, Depression, Chronic Pain, and Parkinson's Disease with Dyskinesia. During an observation on 5/29/2025 at 10:51 AM, in Resident #37's room revealed the residents room contained a personal refrigerator. The contents of the refrigerator contained a plastic bag which contained a fried pie and was unlabeled and undated. Continued observation revealed a disposable foam container which contained baked food items, undated and unlabeled. During an interview on 5/29/2025 at 11:30 AM, the Director of Nursing (DON) stated it was the responsibility of the housekeeping staff to clean, maintain, and perform and record daily temperature checks of the residents' personal refrigerators. During an interview and observation on 5/29/2025 at 11:50AM, the Regional [NAME] President and Regional Director of Nursing confirmed the food items in Resident #13's and #37's personal refrigerators were not stored according to the facility's policy.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observations, and interview the facility staff failed to perform hand hygiene prior to distributing meal service to 5 residents (Residents #70, #277, #71, #25, and #16) of 18 residents observed on the secured unit during lunch service. The findings include: Review of the facility's policy titled, Hand Hygiene, revised 6/13/2023, revealed .facility has adopted .core infection prevention .for safe healthcare delivery in all settings .hand hygiene procedures are to be followed by staff involved in direct resident contact .associates perform hand hygiene .in following situations .Before and after contact with the resident . Review of the facility's policy titled, Resident Dining Services, revised 4/29/2025, revealed .ensure food is served in accordance with professional standards for food service safety .associates involved in dining/food services will perform hand hygiene prior to distributing trays to the residents . 1. The facility staff failed to perform adequate hand hygiene while serving lunch meal trays for Residents #70, #277, #71, #25, and #16. 1a. Review of the medical record revealed Resident #70 was admitted to the facility on [DATE] with diagnoses including Dementia, Delusional Disorders, and Atrial Fibrillation. Review of the comprehensive care plan for Resident #70 revised 3/10/2025, revealed .ADL [Activities of Daily Living] Assistance .needed to maintain or attain highest level of function .assist with ADLS as needed . Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #70 scored a 6 on the Brief Interview of Mental Status (BIMS) assessment which indicated moderate cognitive impairment. Further review revealed the resident required setup assistance with eating. During an observation on 5/27/2025 at 12:35 PM, Certified Nursing Assistant (CNA) A placed the lunch meal tray in front of Resident #70, setup the meal tray for the resident to eat. CNA A did not wash or sanitize the hands after serving Resident #70's lunch meal tray. 1b. Review of the medical record revealed Resident #277 was admitted to the facility on [DATE] with diagnoses including Fracture of Superior Rim of Right Pubis, Anemia, and Heart Failure. Review of the comprehensive care plan for Resident #277 revised 5/19/2025, revealed .resident has an ADL self-care performance r/t Dementia .EATING .resident requires supervision . Review of an admission MDS assessment dated [DATE], revealed Resident #277 scored a 3 on the BIMS assessment which indicated severe cognitive impairment. Further review revealed the resident required supervision with eating. During an observation on 5/27/2025 at 12:36 PM, CNA A placed the lunch meal tray in front of Resident #277, setup the meal tray for the resident to eat. CNA A did not wash or sanitize the hands after serving Resident #277's lunch meal tray. 1c. Review of the medical record revealed Resident #71 was admitted to the facility on [DATE] with diagnoses including Dementia, Depression, and Hypertension. Review of the comprehensive care plan for Resident #71 revised 4/7/2025, revealed .ADL Assistance .needed to maintain or attain .highest level of function .Assist with .ADLS as needed . Review of a quarterly MDS assessment dated [DATE], revealed Resident #71 scored a 6 on the BIMS assessment which indicated the resident had moderate cognitive impairment. Further review revealed the resident required setup assistance with eating. During an observation on 5/27/2025 at 12:38 PM, CNA A placed the lunch meal tray in front of Resident #71, setup the meal tray for the resident to eat. CNA A did not wash or sanitize the hands after serving Resident #71's lunch meal tray. 1d. Review of the medical record revealed Resident #25 was admitted to the facility on [DATE] with diagnoses including Alzheimer's, Depression, and Dysphagia. Review of the comprehensive care plan for Resident #25 revised 5/16/2025, revealed .functional care plan .has limited physical mobility r/t [related to] Weakness . Review of a quarterly MDS assessment dated [DATE], revealed Resident #25 scored a 4 on the BIMS assessment which indicated severe cognitive impairment. Further review revealed the resident was dependent upon staff assistance for feeding. During an observation on 5/27/2025 at 12:42 PM, CNA A placed the lunch meal tray in front of Resident #25, setup the meal tray for the resident to eat. CNA A did not wash or sanitize the hands after serving Resident #25's lunch meal tray. 1e. Review of the medical record revealed Resident #16 was admitted to the facility on [DATE] with diagnoses including Dementia, Hypertension, and Depression. Review of the comprehensive care plan for Resident #16 revised 4/7/2025, revealed .ADL .resident is at risk for ADL . requires assistance related to Dementia . Review of an annual MDS assessment dated [DATE], revealed Resident #16 scored a 3 on the BIMS assessment which indicated severe cognitive impairment. Further review revealed the resident was able to feed self after setup of tray. During an observation on 5/27/2025 at 12:45 PM, CNA A placed the lunch meal tray in front of Resident #16, setup the meal tray for the resident to eat. CNA A did not wah or sanitize the hands after serving Resident #16's lunch meal tray. During an interview on 5/27/2025 at 12:50 PM, CNA A confirmed that she had not performed hand hygiene after serving Residents #70, #277, #71, #25, and #16 the lunch meal tray. CNA A confirmed that she should have washed or sanitized her hands after passing each resident's meal tray. During an interview on 5/29/2025 at 1:40 PM, the Director of Nursing (DON) confirmed staff should wash or sanitize hands between passing each resident's meal trays. The DON confirmed CNA A did not perform hand hygiene after serving Residents #70, #277, #71, #25, and #16 lunch meal tray.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, observations, and interviews, the facility failed to ensure medical information was not visible for 1 resident (#12) of 79 residents reviewed for dignity. The findings include: Review of the facility's policy titled, Dignity, dated 8/3/2021, showed .Each resident has the right to be treated with dignity and respect. Interactions and activities with residents by staff .or volunteers must focus on maintaining and enhancing the resident's self-esteem, self-worth .The resident has a right to a dignified existence .A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life .The facility must protect and promote the rights of the resident . Review of the facility's policy titled, Preservation of Resident's Rights, dated 8/7/2021, showed .The Social Services staff promote and advocate the preservation of residents' rights .All associates are responsible for the preservation of resident's rights .Each resident has the right to be treated with dignity and respect .The Social Services staff ensure that signs are not posted unless they are related to precautionary measures (e.g. [example], oxygen in use or isolation). Signs that reveal personal and medical information re [are] not posted in an area accessible to other residents, visitors, or family . Review of the medical record showed Resident #12 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Hemiplegia and Hemiparesis, Dysphagia, and Gastrostomy Status. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], showed Resident #12 had severe cognitive impairment. During observations on 4/11/2022 at 12:17 PM, 4/11/2022 at 12:59 PM, 4/12/2022 at 5:45 AM, and 4/12/2022 at 7:38 AM, there was 1 sign posted on the wall on the left side of the bed that read, Caregivers who assist w/ [with] eating meals .please alternate 1 bite/1 sip .small bites/sips .encourage 'hard' swallow (effortful) .positioning .as close to 90 [degrees] as possible .Thank You!! [smiley face] .[named staff member] .SLP [Speech Language Pathologist] . The sign was visible to anyone who entered the room. During an interview on 4/13/2022 at 9:08 AM, the Social Services Director stated it was the expectation of the facility that no signs are posted that contain resident medical or personal information unless requested by the resident or family. During an observation and interview on 4/13/2022 at 9:11 AM, in Resident #12's room, the Social Services Director confirmed the sign was present and visible to anyone who entered the room. The Social Services Director confirmed the sign contained medical information and Resident #12's dignity was not maintained. During an interview on 4/13/2022 at 9:20 AM, the Director of Nursing (DON) stated it was the expectation of the facility that signage only be posted when requested by the resident or the resident's representative. During an interview on 4/13/2022 at 9:30 AM, the Speech Therapist confirmed that she posted the sign in Resident #12's room to communicate safety techniques for reducing aspiration to staff that assisted the resident with feeding. Further interview confirmed Resident #12 and Resident #12's family had not requested the sign to be posted.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, the facility investigation, medical record review, and interview the facility failed to report a resident-to-resident alleged abuse for 1 resident (Resident #31) out of 24 residents reviewed for abuse. The findings include: Review of the facility's policy titled, Protection of Residents: Reducing the Threat of Abuse and Neglect, dated 8/10/2021, revealed .In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: Ensure that all alleged violations involving abuse .are reported not later than 2 hours after allegation is made, if the events that cause the allegation involve abuse .to the administrator of the facility and to other officials (including to the State Survey Agency .) . Resident #14 was admitted to the facility on [DATE] with diagnoses including Anxiety, Osteoarthritis, Hypertension, and Depression. Review of a nurse progress note dated 11/15/2021 timed 11:30 AM by Licensed Practical Nurse (LPN #3), revealed Resident #14 .was up in w/c [wheelchair] .[Resident #31] was in front of her [Resident #14] she told him [Resident #31] to move he [Resident #31] didn't so .[Resident #14] slapped him [Resident #31] on the left hand .separated immediately 15 min [minute] check started family notified dr [doctor] .notified order noted for psych [psychiatric] eval [evaluate] and treat as indicated . Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #14 had moderate cognitive impairment. The resident required extensive to total assistance of 1-2 staff members for transfers, mobility, toileting, and supervision with locomotion and eating. The MDS showed no documented behaviors. Resident #31 was admitted to the facility on [DATE] with diagnoses to include, Hemiplegia and Hemiparesis Left Non-Dominant Side, Cerebral Infarction, Legal Blindness, and Diabetes Type 2. Review of the facility's investigation dated 11/15/2021, revealed no injury noted to Resident #31. The skin assessment completed for Resident #31 showed no bruising or redness to left hand. Resident #14, the alleged perpetrator, was placed on 15-minute check awaiting psych evaluation. The facility Interdisciplinary Team (IDT) identified other residents in the facility with the potential for anger outbursts they felt could lead to aggression with other residents. Care plans were updated and the staff were aware of the interventions. Staff were re-educated on the abuse/neglect policy. Review of an annual MDS assessment dated [DATE], revealed Resident #31 was cognitively intact. The resident required extensive to total assistance of 1-2 staff members for transfers, mobility, toileting, and feeding. During an interview on 4/13/2022 at 12:15 PM, Resident #31 revealed he was blind and another resident hit him on his left hand in November 2021 (unable to recall exact date/time). stated . it did not hurt, and she has not done it again . During an interview on 4/13/2022 at 1:50 PM, LPN #3 revealed Resident #14 was coming out of her room and Resident #31 was propelling self in hallway in front of Resident #14's door. Resident #14 told Resident #31 to move. Resident #14 wheeled out the door, Resident #31 was in front of Resident #14's wheelchair. Resident #31's hand was on the hemi tray (plastic support device attached to wheelchair), Resident #14 accidently grazed Resident #31's hand with her hand as she was bringing her hands down to self propel her wheelchair. Resident #14 did not intend to hurt Resident #31. LPN #3 assessed Resident #31's left hand for injury and none was noted. LPN #3 futher stated they were in-serviced on abuse and what to do if abuse occurs. During continued interview LPN #3 explained she had documented in the nurses note that Resident #14 slapped him (Resident #31) on the hand, but should have worded it as touched or grazed hand while she (Resident #14) was self propelling in wheelchair. LPN #3 stated her description did not accurately reflect the incident. During an interview on 4/13/2022 at 1:33 PM, the Administrator confirmed the alleged abuse between the two residents was not reported to the State Survey Agency. Further interview revealed after investigation she felt like it was an accidental encounter.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure a dialysis contract was in place for 1 resident (Resident #1) of 1 resident reviewed for dialysis. The findings include: Resident #1 was admitted to the facility on [DATE] with diagnoses including Acute and Chronic Respiratory Failure, Chronic Systolic Heart Failure, Dementia, End Stage Renal Disease, and Dependence on Renal Dialysis. Review of a physician's order dated 12/9/2021, showed Resident #1 .Receives dialysis at [named dialysis center] .send to dialysis on Monday, Wednesday, and Friday . Review of the annual Minimum Data Set (MDS) assessment dated [DATE], showed a Brief Interview for Mental Status (BIMS) score of 8 indicating Resident #1 had moderate cognitive impairment. Continued review showed the resident was receiving dialysis. Review of the Pre/Post Dialysis Communication forms dated 4/2021-4/2022, showed ongoing communication was being maintained with the dialysis center. During an interview on 4/13/2022 at 9:55 AM, the Administrator confirmed Resident #1 received dialysis at (named dialysis center) and a contract had not been established with the dialysis center.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, and interview the facility failed to follow a Psychiatric recommendation and Physician's Order for 1 resident (Resident #47) of 19 resident's reviewed for physician orders. The findings include: Review of the facility policy titled, Physician Order, revised 3/17/2022 showed .A physician, physician assistant or nurse practitioner [NP] must provide orders for the resident's immediate care and ongoing care of the resident. The facility is obligated to follow and carry out the orders of the prescriber in accordance with all applicable state and federal guidelines .Any orders written by a consulting physician must be reviewed and signed by the resident's attending physician . Resident #47 was admitted to the facility on [DATE] with diagnoses including Unspecified Dementia with Behavioral Disturbance, Unspecified Psychosis, Generalized Anxiety Disorder, and Depressive Episodes. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] showed Resident #47 scored a 3 on the Brief Interview for Mental Status (BIMS) assessment which indicated the resident had severe cognitive impairment. Review of the comprehensive Care Plan dated 3/1/2022 showed Resident #47 was dependent upon staff for meeting emotional, intellectual, physical, and social needs related to cognitive deficits, had a diagnosis of Dementia, and resided on the secured unit. The care plan showed the resident had behavioral problems, was resistive to care, and had the potential to be verbally aggressive related to Dementia. The care plan showed the resident was at risk for changes in moods and behaviors and used psychotropic medications related to Depression and Psychosis with interventions including administer psychotropic medications as ordered. Review of the Physician's Orders dated 3/1/2022-3/31/2022 showed Seroquel (anti-psychotic medication) 25 milligram (mg) in the morning and 50 mg at bedtime. Review of the Medication Administration Record (MAR) dated 3/1/2022-3/31/2022 showed the resident was administered Seroquel 25 mg in the morning and 50 mg at bedtime. Review of the Psychiatric Periodic Evaluation dated 3/14/2022, showed the resident was evaluated for management of Dementia with Behavioral Disturbance and Agitation. Continued review showed the Psychiatric NP recommended an increase in the Seroquel to 75 mg twice daily due to severe agitation and delusions. Further review showed the recommendation was reviewed and initialed by the attending physician and noted okay on 3/24/2022. During review of the resident's medical record and interview on 4/12/2022 at 1:57 PM, with Licensed Practical Nurse (LPN) #1, the LPN stated the resident was known to have occasions of verbally and physically aggressive behaviors. Review of the resident's medical record with the LPN showed a psychiatric note dated 3/14/2022 a recommendation for an increase in Seroquel to 75 mg twice daily due to continued severe agitation and delusions. The physician noted okay and initialed the document on 3/24/2022 which indicated the physician was in agreement for the increased dosage of Seroquel. Review of the 3/2022 and 4/2022 MAR's with LPN #1 showed the increased dose of Seroquel had not been increased or transcribed to the MAR on 3/24/2022 and the medication had not been administered to Resident #47. During an interview on 4/12/2022 at 2:32 PM and on 4/13/2022 at 8:45 AM, the Director of Nursing (DON) stated the Psychiatric Note dated 3/14/2022 which recommended an increase of the resident's Seroquel to 75 mg twice daily had been reviewed, noted and initialed by the physician on 3/24/2022 which indicated the physician was in agreement to the increase dosage of Seroquel. The DON stated the increased dose of Seroquel to 75 mg twice daily was missed by the nurse and had not been transcribed to the resident's MAR. The DON further confirmed Resident #47 did not receive the increased dose of Seroquel as recommended by the Psychiatric NP and as ordered by the Physician.

Based on facility policy review, observation, and interview, the facility failed to ensure opened medications were labeled and dated in 1 of 2 medication carts viewed for medication storage (A/B Hall Medication Cart). The findings include: Review of the facility policy titled, Storage and Expiration Dating of Medication, Biologicals, revised 1/1/2022, showed .Once any medication .is opened .Facility staff should record the date opened on the primary medication container (vial, bottle, inhaler) . During an observation on 4/12/2022 at 1:24 PM, of the A/B halls medication cart showed 1 multiple dose bottle of fluticasone propionate (a nasal steroid medication) 50 micrograms (mcg) nasal spray, opened and undated; 1 multiple dose bottle of azelastine (an allergy nasal antihistamine) 205.5 mcg/0.137 milliliters (ml) nasal spray opened and undated; 1 multiple dose bottle liquid loperamide (a diarrhea medication) 1 milligram (mg)/ 7.5 ml (floor stock), over 3/4 empty, opened and undated; 1 multiple dose bottle of geri-lanta (antacid/anti-gas supplement), over 1/2 full, opened and undated; 1 multiple dose bottle of bismuth subsalicylate (a medication used to treat heartburn, diarrhea, nausea, and upset stomach), over 1/2 full, opened and undated; and 1 multiple dose bottle of geri-tussin (a liquid medication used to treat chest congestion) 100 mg/5 ml, a full bottle, opened and undated. During an interview on 4/12/2022 at 1:24 PM, Licensed Practical Nurse #2 stated medications should be dated when opened. During an interview on 4/12/2022 at 1:31 PM, the Director of Nursing stated it was her expectation that medications be dated when opened.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, record review, and interview, the facility failed to designate an employee of the facility to assume responsibility for collaborating and coordinating care between the nursing home and the hospice entity, and failed to obtain the most recent hospice plan of care for 1 resident (Resident #19) of 5 residents reviewed for hospice services. The findings include: Review of the facility's policy titled, Area of Focus: Hospice, undated, showed, .The facility must designate a member of the interdisciplinary team .to ensure .the resident receives quality care in collaboration with the facility staff and the hospice staff. Review of the facility's policy titled, Hospice Coordination of Care, last reviewed 5/7/2021, showed, .interdisciplinary team member is responsible .Collaborating with hospice representatives and coordinating LTC [long term care] facility staff participation in the hospice care planning process .Obtaining the following information from the hospice .most recent hospice plan of care specific to each resident .Each LTC facility providing hospice care .must ensure that each resident's written plan of care includes both the most recent hospice plan of care and a description of the services furnished by the LTC facility to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being . Resident #19 was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease, COVID-19, Chronic Respiratory Failure, Encounter for Palliative Care, and Dysphagia. Review of Resident #19's Physician's Order dated 1/27/2022, showed, .Admit to hospice level of care . Review of a comprehensive Care Plan, last reviewed 2/23/2022, showed .resident has a terminal prognosis .Current patient with [name of hospice entity] . During an interview on 4/12/2022 at 1:31 PM, Licensed Practical Nurse (LPN) #2 confirmed there was no hospice care plan in Resident #19's medical record. During an interview on 4/12/2022 at 2:03 PM, the Social Services Director stated she was not responsible for coordination of care between the facility and the hospice entity. She also stated the Admissions Coordinator was responsible for acquiring the hospice plan of care if a resident was admitted to the facility with hospice services, and the MDS coordinator was responsible for the coordination of care between the facility and the hospice entity. During an interview on 4/12/2022 at 2:12 PM, the MDS Coordinator stated she was not the contact person at the facility responsible for coordination of care between the hospice entity and the facility. During an interview on 4/12/2022 at 2:17 PM, the Admissions Coordinator stated the hospice entity was responsible to ensure the facility had an updated hospice plan of care for Resident #19. She also stated she was not the coordinator at the facility for communication between the hospice entity and the facility. During an interview on 4/12/2022 at 2:27 PM, the Director of Nursing confirmed the Social Services Director was the contact person at the facility responsible for the coordination of care between the facility and the hospice entity. She also confirmed there was not a hospice plan of care in Resident #19's medical record.