Inspection·September 5, 2025

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility policy and procedures, resident and staff interviews, the facility failed to maintain an effective pest control program to ensure an environment free from pests for 2, (Resident #400 and #500), of 97 residents residing in the skilled nursing facility.The findings included:The facility Policy and Procedure, HL-200 (11/30/14) specified the facility will maintain a pest control program which includes inspection, reporting and prevention.Procedure: Treatment will be rendered as required to control insects and vermin. Any unusual occurrence or sighting of insects should be reported immediately to the Supervisor. Proper action will be taken. On 9/4/25 at 9:04 a.m., during an initial tour of the facility two brown bugs were observed crawling up the wall in the bathroom of an occupied resident room. Licensed Practical Nurse (LPN) Staff J noted the observation and left the room. Certified Nursing Assistant (CNA) Staff A was present and said, All the time, they are everywhere, all the time. You tell them and they are spray, and they are still here. On 9/4/25 at 9:20 a.m., in an interview Resident #400 said, I see roaches here every night. I've been telling everyone there is a problem here. Last night one crawled on my bedside table during the meal, it came right on up. On 9/4/25 at 9:30 a.m., in an interview Registered Nurse (RN) Staff E said, Oh yeah bugs are everywhere in here, real bad. But the Administrator said he got someone to come and spray last week. On 9/4/25 at 9:44 a.m., in an interview Resident #500 said, I told the management here and I've asked to be transferred to another facility, but they are trying to talk me into staying. I have been here three weeks, and I see roaches all over the floor, they run under the bed. I saw three last night and I had to stomp on one with my foot.On 9/4/25 at 10:08 a.m., in an interview CNA Staff D said, There are a lot of bugs and roaches in this whole building. They mostly are in the resident drawers, and they come out from the air-conditioning units. I have seen that. On 9/4/25 at 10:12 a.m., in an interview the Maintenance Assistant said, Yes I have seen roaches in here, but they come and spray every Tuesday. Review of the facility Pest Sighting Log located on each of the three nursing units documented:On the 300 unit the following was reported: 6/16/25 roaches, staff breakroom. 8/6/25 roaches in rooms.On the 100 unit the following was reported: Roaches observed on 7/24/25, 8/1/25, 8/2/25, 8/6/25, 8/19/25, 8/21/25, 9/1/25, 9/2/25 in resident rooms.On the 200 unit the following was reported: 7/16/25 ants in bed, 7/28/25 ants in Director of Nursing office, 8/11/25 ants in bed, 8/14/25 roaches in rehab gym, 8/16/25 roaches in rooms, 8/18/25 roaches in rooms, 8/19/25 roaches in activity room and on my desk and coming out of each table in the C wing dining room. On 9/2/25 ants in rooms crawling on the beds and in drawers. On 9/4/25 ants and roaches seen in rooms. Review of the pest control logs from [NAME] Exterminators:On 9/2/25- Exterior rodent station, roof rats-gnawing. Rodent droppings were found. Interior of the building documented no activity for roaches and ants.On 8/11/25- Bed bug treatment for room on B Wing. The exterminator provided a Bed bug Customer Preparation Checklist. A service agreement was signed on 8/4/25 to treat bed bugs in Wing B.On 8/5/25 the interior of the facility was treated for roaches with no activity noted.On 7/31/25 documented Having issues with roaches and fruit flies in kitchen. On 9/4/25 at 12:04 p.m., in an interview with the Maintenance Director, he said he was aware of the bug problem and pest control comes every other Tuesday and he reports it. He was informed of the bugs observed during the tour of the facility today. He said, I have the staff write down in the pest log when and where they see them and the pest control will check the logs. I check them daily but there is nothing I can do; we have nothing to spray them with. If I call the pest control, they will come if they can, sometimes they are booked up and can't come. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106000 If continuation sheet Page 2 of 2