Inspection visit

InspectionMarch 29, 2024

GOLDWATER CARE SPRING VALLEYCMS #14548613 citations on this visit

13 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 13 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** B) The facility's Weight Assessment and Intervention policy and procedure, dated 2020, documents: If the weight change is planned or related to fluid management and is determined to be desirable, it will be documented and no change in the care plan will be necessary. Care planning for undesirable weight loss or impaired nutrition shall be a multidisciplinary effort and will include the physician, nursing staff, Registered Dietitian, a member for the Food and Nutrition Department, consultant pharmacist, and the resident or the resident's legal surrogate. Care plans will consider the wishes of the resident and right to choose their treatment plan. Individualized care plans shall address the following to whatever extent possible: Identified of the problem that is causing the weight loss; Goals with measurable time frame for improvement; Interventions/approaches; A weight loss regimen shall not be initiated for a cognitively capable resident without his or her involvement and approval; and If a resident declines to participate in weight loss goal, the Registered Dietitian shall document the resident's wishes and respect them. The annual MDS (Minimum Data Set) assessment for R8, dated 1/17/24, documents R8 with significant weight loss and not on a physician-prescribed weight loss regimen. This MDS does not include a diagnosis of Obesity and is without difficulty swallowing. The current Order Summary Report for R8 includes the following physician orders: 4/21/23 General diet, Regular texture, Regular consistency for diet; 7/12/23 House Nutrition Supplement two times a day for unplanned weight loss, 120cc (cubic centimeters) 1/2 cup BID (twice daily); 4/26/23 Divided plate at all meals: cut up food as needed every shift; 9/18/23 Mirtazapine 7.5 mg (milligrams) by mouth at bedtime for appetite stimulant. This Order Summary Report does not document a physician order for a weight loss program for R8. The current Care Plan for R8 does not include a nutritional plan of care for R8 or address R8's significant weight loss. This Care Plan does not document R8 with planned weight loss program and does not include supplements or medications for weight loss. On 3/26/24 at 9:59 AM, R8 stated he lost weight the first five or six months after admitting to the facility. R8 stated, I lost 90 pounds. I have gained some of it back, but not all of it. R8 stated he does not eat breakfast and never has but usually goes down for lunch and dinner. On 3/28/24 at 10:01 AM, R8 stated he is not trying to lose weight, and no one has talked to him about a weight loss program or he would have told them no. The facility EHR (electronic health record) documents R8's admission weight on 2/27/23 as 278.0 lbs. (pounds) with the following monthly weights as: 3/2/24 at 266.0 lbs.; 4/21/23 at 254.0 lbs.; (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 14 Event ID: 145486 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 5/3/24 at 240.0 lbs.; 6/1/23 at 224.0; 7/2/23 at 219.0 lbs.; 8/2/23 at 223.0 lbs.; 9/5/23 at 212.0 lbs.; 10/2/23 at 210.0 lbs.; 11/3/23 at 213.0 lbs.; 12/1/23 at 208.0 lbs.; 1/1/23 at 206.0 lbs.; 2/7/24 at 212.0 lbs.; and 3/1/24 at 205.0 lbs. This EHR documents R8 with a weight loss of 73 pounds since 2/27/23 admission and total loss of 49 pounds since last survey date of 4/10/23. On 3/27/24 at 2:15 PM, V6 DM (Dietary Manager) provided the RD lists of residents seen monthly. This list documents V16 RD reviewed and assessed R8's weights and overall nutritional assessment in August, September, October, and December 2023 for planned weight loss. The RD monthly, quarterly, and annual assessments, dated 5/12/23, 6/12/23, 7/12/23, 8/7/23, 9/11/23, 10/12/23, 12/11/23, and 1/30/24 document R8 with favorable and planned significant weight loss, and refusing breakfast at times. On 3/28/24 at 2:30 PM, V3 MDS (Minimum Data Set)/CPC (Care Plan Coordinator) stated we only do planned weight loss programs if there is a physician's orders which R8 does not have. V3 MDS/CPC confirmed R8's Care Plan does not include a nutritional plan of care or address R8's significant weight loss and stated she will make sure the Care Plan is developed. C) A Physician Order, dated 09/28/23, documents to change R24's Indwelling Urinary Catheter every 28 days and as needed to prevent further breakdown of Stage Four Pressure Ulcers on R24's Right and Left Buttocks. R24's Care Plan, dated 12/21/23, does not address R24's Indwelling Urinary Catheter or include measurable objectives and timeframes to meet R24's needs. On 03/28/24 at 10:49 am, V3 (Care Plan Coordinator) confirmed R24's current Care Plan does not include an Indwelling Urinary Catheter or objectives for an Indwelling Urinary Catheter. V3 stated R24's Indwelling Urinary Catheter was removed on 07/21/23 and reinserted in 8/23, at which time it was not added back into R24's current Care Plan. Based on record review and interview, the facility failed to develop a Comprehensive Care Plan for three residents (R8, R24, and R35) of 29 residents reviewed for Care Plans in a sample of 29. Findings includes: The facility's Comprehensive Care Plan dated 11/17/17 documents: To develop a Comprehensive Care Plan that directs the care team and incorporates the resident's goals, preferences, and services that are to be furnished to attain or maintain the resident's highest practical physical, mental, and psychosocial well-being. The facility will develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. A) Facility's Smoking Safety Policy dated 10/24/22 documents: Smoking includes the use of electronic cigarettes and vaping devices. Resident's plan of care and smoking compliance will be reviewed quarterly. Facility's Smoking Safety Risk Assessment Policy dated 8/9/19, documents: The purpose of the Smoking Safety Risk assessment is to determine the individual's ability and willingness to comply with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 2 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm facility rules and regulations governing smoking. Additionally, the assessment helps to determine the extent of the individual's smoking habit and his/her interest in smoking cessations. R35's current Smoking Safety Risk assessment dated [DATE] documents: 1. Does the resident currently smoke or use electronic smoking device? No--resident does not smoke. Residents Affected - Few R35's current Care Plan does not document R35's vaping/smoking and/or non-compliance with vaping/smoking. Facility's Resident Smokers and Smoke Time List Updated 3/20/24, does not document R35 as a smoker or vaper. R35's Progress Note dated 3/18/24 documents: As this Registered Nurse/RN was giving (R35's) night medications, saw a vape pen on her bed. Unsure if it's a regular or THC vape pen. Refused to surrender it to staff. Refused to disclose on how she obtained vape pen. Explained facility protocol. (R35) got upset and stated, Give it back to me! I am so tired of losing my pens! (R35) does have history of being caught with THC vape pen at bedside. She used to have a pattern of developing respiratory and gastrointestinal/GI symptoms whenever she uses THC vape pen before. (THC/Tetrahydrocannabinol-organic chemical found in cannabis, per Internet Definition dated 3/28/24.) R35's Progress Note dated 3/13/24 documents: It was discussed with the patient today her current pain management and the use of marijuana vape pens. (R35) did not confirm or deny that she has been using marijuana vape pens recently. R35's Progress Note dated 12/15/23 documents: (R35) assessed. (R35) angry because she cannot use her marijuana vape pen. (R35) counseled and educated. Support given. On 3/27/24 at 1:45pm, V12 Activity Director stated: I do not keep vaping or marijuana paraphernalia for (R35); (R35's) paraphernalia was taken from (R35) and was locked in safe in (V1 Administrator's) office. On 3/28/24 at 10:55am, V11 Registered Nurse/RN stated that she had taken vaping pens from (R35) on two occasions, that the first pen contained THC, but not sure if the second pen contained THC or not. On 3/27/24 at 1:47pm, V13 Social Services Director/SSD stated that R35 does vaping without supervision; stated that intervention was done of taking (R35's) paraphernalia away and educating (R35); stated that no one had actually seen (R35) smoking or vaping. On 3/28/24 at 9:20am, V13 SSD, stated that R35's issues relating to smoking or vaping were not included on R35's Care Plan. V13 SSD stated, (R35) denies smoking; the smoking assessments will say 'No'; no one actually saw (R35) smoke. On 3/28/24 at 9:30am, V3 Minimum Data Set/MDS/Care Plan Coordinator stated that she did not include smoking focus or interventions on R35's Care Plan. On 3/27/24 at 1:50pm, R35 stated that she uses a vape pen for marijuana once in a while, that this settles her down. R35 stated, None of your business who brings it. I will keep it; don't want to let Activity have it; it does not affect my breathing; I can breathe better after using it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 3 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm On 3/28/24 at 9:40am, V2 Director of Nursing/DON stated: (R35's) continued non-compliance with smoking and use of marijuana paraphernalia should have been included in R35's Care Plan along with interventions and education. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 4 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0657 Level of Harm - Minimal harm or potential for actual harm Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on observation, interview, and record review the facility failed to revise a plan of care for two (R27 and R49) of 29 residents reviewed for care planning in the sample of 29. Residents Affected - Few Findings include: The facility's Comprehensive Care Plan policy and procedure, revised 11/17/17, documents the care plan is to be Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments; and The care plan should be revised on an ongoing basis to reflect changes in the resident and the care that the resident is receiving. On 3/28/24 at 2:30 PM, V3 MDS (Minimum Data Set)/CPC (Care Plan Coordinator) confirmed resident Care Plans are to be revised as needed. 1. The current Care Plan for R27, documents the following focus areas for R27: Potential nutritional problem related to swallowing disorder, dependent on nutrition by PEG (percutaneous endoscopic gastrostomy) tube; Swallowing problem related to dysphasia; and unplanned/unexpected weight loss related to poor food intake. The following interventions for the focus areas include: Bolus feedings, NPO (nothing by mouth), G-tube for nutrition, and add pudding to lunch and supper meals. The current Order Summary Report for R27, documents the following dated physician orders as: 7/23/21 General diet, Mechanical Soft texture, thin consistency, may have small meals d/t (due to) TF (tube feeding) at HS (hour of sleep) for diet; and 12/20/21 Resident to sit upright 90 degrees during meals. There is currently no physician order for Bolus feedings, NPO status, or adding pudding to lunch and supper meals. The EHR (electronic health record) for R27, documents R27's weight on 3/4/24 as 125.0 pounds indicating an 8.09% (percent) weight loss in last five months between 10/2/23 and 3/4/24. There are no documented interventions for this gradual weight loss for R27. On 3/26/24 at 11:11 AM, R27 was lying in bed with eyes closed. A G-tube pump was next to R27's bed without feeding hanging and was turned off. On 3/27/24 at 11:53 AM, R27 was lying in bed. On this same date at 12:25 PM, staff entered R27's room with a meal tray and then exited the room with the same meal tray. On 3/27/24 at 12:49 PM, R27 was lying in bed on his back and stated he was not going to eat today and I'm not hungry. On 3/27/24 at 12:50 PM, V18 CNA (Certified Nursing Assistant) stated she took R27 his lunch and (R27) refused to eat today. He sometimes does that. On 3/28/24 at 10:00 AM, V9 CNA stated R27 eats pretty good but does refuse to eat at times. On 3/28/24 at 2:30 PM, V3 MDS (Minimum Data Set)/CPC (Care Plan Coordinator) confirmed R27 is no longer dependent by PEG tube feedings, no longer gets bolus G-tube feedings, is no longer NPO, and the pudding was discontinued. V3 MDS/CPC stated she would update R27's Care Plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 5 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. The current Care Plan for R49, documents the following focus areas for R49 as: COPD (Chronic Obstructive Pulmonary Disease) related to smoking with intervention for Oxygen at 5L (liters) via nasal cannula; On Antibiotic therapy related to pneumonia infection; and Indwelling urinary catheter. The current Order Summary Report for R49, documents the following dated physician orders as: 3/5/24 Oxygen at 5L continuously via nasal cannula, SpO2 (blood oxygen level) above 90% every shift and change oxygen tubing every Sunday on night shift; 3/5/24 Change urinary catheter 18 Fr (french) 10 cc (cubic centimeter) balloon every 28 days on night shift, Urinary catheter care every shift and as needed, and monitor urinary catheter output three times daily. There is no physician ordered antibiotic on R49's current Order Summary Report. On 3/26/24 at 10:11 AM, R49 was sitting upright in his bed without oxygen on. An oxygen concentrator was resting on floor next to (R49's) bed and not being used at this time. R49 also had visible urinary catheter tubing connected to a urinary drainage bag attached to his bed frame. R49 stated he uses the oxygen three or four times a day when he is short of breath, puts the oxygen tubing on, turns the machine on himself, and adjusts the oxygen to what he needs, when he needs it. R49 also stated, I clean it myself. They don't do it. They empty it for me if I haven't already. On 3/26/24 at 11:34 AM, R49 stated he was admitted to the facility with Pneumonia and was on an antibiotic and finished it shortly after coming to the facility. On 3/27/24 at 11:55 AM, R49 was lying in bed on his back with oxygen on at 4.5 L (liters) via nasal cannula. On 3/27/24 at 12:30 PM, R49 was sitting up on the side of his bed eating lunch with oxygen on or infusing at this time. On 3/27/24 at 1:30 PM, R49 was lying in bed without oxygen on and refused to allow catheter care and stated I already did that this morning. I do it first thing in the morning, every time I go to the bathroom and before I go to bed. On 3/28/24 at 10:06 AM, V10 RN (Registered Nurse) stated R49 is independent with his oxygen and will put it on and remove it himself. V10 RN stated R49 takes care of his own catheter at times as well. On 3/28/24 at 2:30 PM, V3 MDS (Minimum Data Set)/CPC (Care Plan Coordinator) confirmed R49 is no longer on the antibiotic and stated she was unaware that R49 was not using his oxygen continuously, was managing his own oxygen and performing his own urinary catheter care and would make sure to revise R49's Care Plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 6 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed obtain a physician order for a weight loss program and to ensure a resident with significant weight loss was monitored and followed by a physician for one (R8) of three residents reviewed for weight loss in the sample of 29. Residents Affected - Few Findings include: The facility's Weight Assessment and Intervention policy and procedure, dated 2020, documents The goal is to ensure adequate parameters of nutritional status are maintained by preventing unintentional weight loss. Any weight change of 5% (percent) or more since the previous weight assessment shall be re-taken the next day to confirm. If the weight is verified, nursing will notify the appropriate designated individuals such as the physician, Registered Dietician, Dining Services Manager, or other members of the interdisciplinary team within 24 hours. Verbal notification must be confirmed in writing. The threshold for significant unplanned and undesired weight loss shall be based on the following criteria: 1-month significant loss - 5% and severe loss greater than 5%; 3 months significant loss - 7.5% and severe loss greater than 7.5%; and 6-month significant loss - 10% and severe loss greater than 10%. If weight change is planned or related to fluid management and is determined to be desirable, it will be documented and no change in the care plan will be necessary. The physician along with the interdisciplinary team will identify conditions and medications that may be causing anorexia, weight loss, or an increased risk of weight loss. A weight loss regiment shall not be initiated for a cognitively capable resident without his or her involvement and approval. If a resident declines to participate in a weight loss goal, the Registered Dietitian shall document the resident's wishes and respect them. The Face Sheet for R8 includes the following diagnoses: Cerebrovascular Disease, Hemiplegia affecting left non-dominant side, Type 2 Diabetes Mellitus, and GERD (Gastro-esophageal Reflux Disease) and does not include a diagnosis of obesity. The current Order Summary Report for R8 includes the following physician orders: 4/21/23 General diet, Regular texture, Regular consistency for diet; 7/12/23 House Nutrition Supplement two times a day for unplanned weight loss, 120cc (cubic centimeters) 1/2 cup BID (twice daily); 4/26/23 Divided plate at all meals: cut up food as needed every shift; 9/18/23 Mirtazapine 7.5 mg (milligrams) by mouth at bedtime for appetite stimulant. This Order Summary Report does not document a physician order for a weight loss program for R8. The annual MDS (Minimum Data Set) assessment for R8, dated 1/17/24, documents R8 with significant weight loss and not on a physician prescribed weight loss program. On 3/26/24 at 9:59 AM, R8 stated he lost weight the first five or six months after admitting to the facility and wasn't trying to. R8 stated, I lost 90 pounds. I have gained some of it back, but not all of it. R8 stated he does not eat breakfast and never has but usually goes down for lunch and dinner. On 3/28/24 at 10:01 AM, R8 stated no one has talked to him about weight loss or about a weight loss program or he would have told them no. The facility EHR (electronic health record) documents R8's admission weight on 2/27/23 as 278.0 lbs. (pounds) with the following monthly weights as: 3/2/24 at 266.0 lbs.; 4/21/23 at 254.0 lbs.; 5/3/24 at 240.0 lbs.; 6/1/23 at 224.0; 7/2/23 at 219.0 lbs.; 8/2/23 at 223.0 lbs.; 9/5/23 at 212.0 lbs.; 10/2/23 at 210.0 lbs.; 11/3/23 at 213.0 lbs.; 12/1/23 at 208.0 lbs.; 1/1/23 at 206.0 lbs.; 2/7/24 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 7 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few at 212.0 lbs.; and 3/1/24 at 205.0 lbs. This EHR documents R8 with a weight loss of 73 pounds since 2/27/23 admission and total loss of 49 pounds since last survey date of 4/10/23. On 3/27/24 at 2:15 PM, V6 DM (Dietary Manager) stated V16 RD (Registered Dietician) comes to the facility monthly or as needed. V16 RD provides a list of who she sees when she is here. V6 DM provided the RD lists of residents seen monthly. This list documents V16 RD reviewed and assessed R8's weights and overall nutritional assessment in August, September, October, and December 2023 for planned weight loss. The RD quarterly Nutrition Assessment for R8, dated 5/12/23 documents R8 weight at 239.0 lbs., requires supervision for eating, and eats 26-75% (percent) of estimated needs. Recently had a sig (significant) wt. (weight) loss of 5.9% x (times) 1 mo (month), and 14% x 3 mo down to 239# (pounds). Recommend continuing the current diet and monitor. No recommendations. The RD Nutrition Progress Note for R8, dated 6/12/23, documents Recently had a sig. wt. loss of 7.1% x 1 mo, to 223# on 6/10/23. Recommend continuing the current diet and monitor. No recommendations. The RD Nutrition Progress Note for R8, dated 7/12/23, documents R8 with significant weight loss of 8% x 2 mo, 13.8% x 3 mo, and 21.2% x 6 mo. down to 219# for July. House supplement recommended - 120 cc BID for extra kcal (kilocalories). The RD Nutrition Progress Note for R8, dated 8/7/23, documents R8 presents at nutritional risk rt (related to) favorable significant weight loss 19.8% x 6 months. R8's August 2023 weight: 223 # and occasionally refuses meals. No Recommendations. The RD Nutrition Progress Note for R8, dated 9/11/23, documents significant weight loss 10.9% x 3 months down to 212#. Continue plan of care. RD available prn (as needed) via nutritional risk referral. No Recommendations. The RD Nutrition Progress Note for R8, dated 10/12/23, documents significant weight loss 17.3% x 6 months, down to 210# for October. Some weight loss is planned. Continue plan of care. No Recommendations. The RD Nutrition Progress Note for R8, dated 12/11/23, documents significant weight loss 12.6% x 6 months down to 208# for December. Some weight loss is planned. General, regular appetite is fair to good, but occasionally refuses meals-dislikes eating breakfast most days. He has a divided plate and meat is cut up for him. Receiving house supplement 120cc BID for extra kcal. Continue plan of care. No Recommendation. The RD annual Nutrition Assessment for R8, dated 1/30/24, documents R8's current weight at 206.0 pounds, requires supervision when eating, eats 76-100% of estimated needs. Annual review: (R8) has had a sig (significant) planned wt (weight) loss of 72# (pounds) from admit weight in Feb of 2023. Admit weight may have been in error. He eats fair to good - at times refuses breakfast. Will continue the current diet and monitor. No recommendations. The Physician Progress Notes for R8 since admission to the facility, dated 3/2/23, 3/9/23, 3/16/23, 3/21/23, 2/23/23, 4/1/23, 4/25/23, 4/27/23, 5/2/23, 5/23/23, 6/13/23, 6/27/23, 6/29/23, 7/13/23, 7/18/23, 8/17/23, 8/24/23, 9/21/23, 1/5/24, 2/21/24, and 3/11/24 do not document R8 being on weight loss program or address R8's significant weight loss. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 8 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/28/24 at 12:54 PM, V6 DM stated she is not aware of R8 being on a planned weight loss program. V6 DM stated (R8) comes out for some meals and we try to get him out more often. Sometimes he does and sometimes he doesn't. On 3/28/24 at 1:08 PM, V16 RD stated she sees all the residents with weight loss monthly. V16 RD confirmed (R8) was on a planned weight loss program and stated R8 was admitted to the facility in the obese range, has had significant weight loss since admission, and V16 RD added the supplement due to gradual decline in R8's weight; and wanted to slow R8's weight loss down. V16 RD also stated since V6 DM hired on, the food is better, and the staff try to get R8 to come out for meals more frequently as R8 will refuse as times. On 3/28/24 at 2:30 PM, V3 MDS (Minimum Data Set)/CPC (Care Plan Coordinator) stated We only do planned weight loss programs if there is a physician's orders which (R8) does not have. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 9 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation, interview, and record review the facility failed to ensure a PEG (percutaneous endoscopic gastrostomy) tube dressing change was completed as physician ordered for one (R27) of one resident reviewed for tube feeding in the sample of 29. Findings include: The facility's Gastrostomy Tube - Feeding and Care policy and procedure revised 8/3/20, documents Stoma Site Care: Inspect the surrounding skin for redness, tenderness, swelling, irritation, purulent drainage, or gastric leakage: immediately report skin irritation or infection and provide treatment. Clean skin with soap and water or antiseptic of choice - begin next to stoma site, using a spiral pattern and moving outward; clean under skin disk with cotton swab. Dry thoroughly; leave area open to air to minimize dampness, skin irritation, and maceration; use a dressing only if ordered. The current Order Summary Report for R27 documents physician treatment order dated 5/9/23: Tx (treatment) to g-tube (gastrostomy tube): Cleanse with soap and water, pat dry, apply bacitracin (antibiotic ointment), cover with (split drain sponge) every night shift and every 24 hours as needed. The current Care Plan for R27 includes intervention for the care of R27's g-tube as: Provide local care to G-tube site as ordered and monitor for s/sx (signs and symptoms) of infection every shift. On 3/27/24 at 11:53 AM, R27 was lying in bed on his back. G-tube dressing to abdomen was noted with the date of 3/24/24 with visible yellow/tan discoloration to the outside of the dressing. When asked R27 when the dressing was changed last R27 stated I don't know. Sometimes they do sometimes they don't. On 3/27/24 at 12:49 PM, R27 remained in bed on his back with g-tube dressing unchanged. On 3/27/24 at 1:30 PM, requested V8 LPN (Licensed Practical Nurse) to accompany this writer to R27's room to verify the date on R27's dressing. V8 LPN stated she was finishing up something first. On 3/27/24 at 2:54 PM, R27's g-tube dressing remained unchanged, dated 3/24/24. V2 DON (Director of Nursing) stated V8 LPN left early due to being ill. V2 DON confirmed R27's g-tube dressing should have been changed by the night nurse. On 3/27/24 at 2:57 PM, V14 RN (Registered Nurse) stated R27's dressing is changed on the night shift and was signed out on the TAR (Treatment Administration Record) on 3/24/24 and 3/25/24 as having been done. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 10 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** B) A physician order dated 12/2/23 for R71 reads to change out, date and label all oxygen tubing/bags and to clean the filter and wipe the machine down every Sunday. Residents Affected - Few On 03/27/24 at 2:11 PM, R71 was laying in bed with oxygen via nasal prong and a concentrator. R71's tubing had no date visible and R71's humidity bottle was dated 02/07/24. On 03/27/24 at 2:17 PM, V14 observed R71's oxygen equipment and confirmed R71's tubing had no date stating, The tape may have been torn off. V14 also stated the date on R71's humidity bottle was, either 02/07 or 02/09/24. V14 stated she was unsure how often humidity bottles should be changed and that she would have to check. Based on observation, interview and record review the Facility failed to clean, maintain and change disposable Respiratory supplies for two of three Residents (R52 and R71) reviewed for Respiratory Care in a sample of 29. Findings include: The Facility Oxygen and Respiratory Equipment (Changing and Cleaning) Policy, revised 1/7/19, documents: to provide guidelines to employees for changing all disposable respiratory supplies; ensure the safety of Residents by providing maintenance of all disposable respiratory supplies; minimize the risk of infection; Nasal Cannulas are to be changed once a week and as needed; a clean plastic bag with a zip lock/draw string will be provided to store the cannula when not in use and will be dated with the date the tubing was changed; and oxygen humidifiers should be changed weekly or as needed and will be dated when changed. The Facility Continuous Positive Airway Pressure/CPAP Therapy Policy, undated, documents: the goal of this therapy is therapy include ventilation, improve sleep, decrease hospitalizations, improve cognitive function, improve oxygen saturation during sleep, decrease work of breathing and improve lung compliance; equipment includes CPAP machine, tubing, oxygen tubing, adapter, mask and humidifier; cleaning and maintenance include wash hands, remove headgear from mask/pillow shell, with a soft cloth, wash the mask/pillow with a solution of warm water and a mild clear liquid detergent, rinse, allow mask/pillow to air dry, clean and inspect all components regularly (mask, tubing and headgear should last approximately six to 12 months, but can vary greatly; clean the CPAP unit as necessary with a damp cloth, wipe the outside of the unit and use a dry cloth to wipe dry; filter maintenance includes replacing disposable filters and reusable filters should be rinsed of dust and allowed to air dry. A) R52's Physician Order Sheet/POS, dated 3/27/24, documents diagnoses including Chronic Obstructive Pulmonary Disease/COPD, Emphysema, [NAME] Disorder, Chronic Respiratory Failure, Type Two Diabetes and Morbid Obesity. The POS also documents Physician Orders for a Bi-level Positive Airway Pressure Machine (Bi-Pap) via full mask with 1:65/E/:5, at bedtime for Sleep Apnea and an order for Oxygen at two to four liters via Nasal Cannula continuous every shift related to COPD and a oxygen tank portable two to four liters by Nasal Cannula related to COPD. The POS does not document orders for cleaning, changing or maintaining respiratory (Oxygen and CPAP) supplies. R52's current Care Plan documents R52's Oxygen therapy. The Care Plan does not document a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 11 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Physician's Order for cleaning, changing or maintaining R52's Respiratory (Oxygen and CPAP) supplies. Level of Harm - Minimal harm or potential for actual harm R52's Treatment Administration Record, dated 3/1/24 through 3/27/24, does not document a Physician's Order for cleaning, changing or maintaining R52's Respiratory (Oxygen and CPAP) supplies. Residents Affected - Few On 3/26/24 at 10:13 am, R52 was sitting in wheelchair in room and R52's oxygen concentrator was running at two liters, and the tubing and cannula were laying on the floor next to R52's bed. R52 stated, My tubing is not long enough to reach, I need longer tubing. R52 picked up the oxygen tubing off of the floor and placed it on R52's face. The tubing was not dated or in a plastic storage bag. R52's humidification bottle was not dated. R52's CPAP tubing and face mask/pillow were hanging/dangling on the side of R52's nightstand, unbagged and undated. R52's face mask/pillow were moderately soiled with a white substance. On 3/27/24 at 1:00 pm, R52, was sitting in R52's wheelchair at the entrance of V1's (Administrator) office doorway, with oxygen setting at two liters, and R52's portable oxygen tank tubing was not dated. On 3/28/24 at 10:39 am, R52's was sitting in bed wearing oxygen tubing and R52's oxygen concentrator was running at two liters. R52's oxygen tubing and humidification bottle were not dated, and a plastic storage bag was not in R52's room. R52's CPAP mask/pillow was in a storage bag, dated 3/28/24. R52's CPAP mask/pillow had a moderate amount of white substance on the inside of the mask/pillow. R52's CPAP supplies could not be located. On 3/28/24 at 10:39 am, V7 (Licensed Practical Nurse/LPN) stated, I cannot find any CPAP supplies. I am not sure who is responsible for changing and cleaning the filters, tubing and mask/pillow. It may be third shift's responsibility, I am not sure. V7 confirmed that there is no documentation for changing or cleaning, the Oxygen and CPAP filters, tubing or mask/pillow on R52's Physician Order Sheet, Treatment Administration Record or Medication Administration Record. On 3/28/24 at , V2 (Director of Nursing) stated, I have posted the Oxygen Policy at the Nurse's Station because we have been having problems and we have lacking with the oxygen cares. The nurses should be dating and changing oxygen and CPAP supplies. On 3/28/24 at 2:10 pm, V1 (Administrator) stated, We just talked to nursing about this because we have been having issues with this. They should be changing, dating and bagging the oxygen and CPAP supplies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 12 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure the ice scoop, for the ice machine, was stored on the outside of the ice machine. This failure has the potential to affect all 79 residents residing in the facility. Findings include: Facility Policy, entitled Cleaning Instructions: Ice Machine and Equipment, dated 2010, document, 10. Store the ice scoop outside the machine in a separate, sanitized container that allows the water to drain and not collect around the scoop. On 03/26/2024, at 9:35 a.m., during the initial kitchen tour, with V6/Dietary Manager, the ice scoop, for the ice machine, was inside of the ice machine and full of ice. V6 confirmed the ice scoop should not be left inside the ice machine, but rather in a container outside of the ice machine. The Centers for Medicare and Medicaid Services form, entitled Long-Term Care Facility Application for Medicare and Medicaid, dated 3/26/2024, signed by V1/Administrator, document, 79 residents reside in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 13 of 14 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the lids, to the trash receptacle, were closed and the area surrounding the trash receptacle was free of litter. This failure has the potential to affect all 79 residents residing in the facility. Residents Affected - Many Findings include: Facility Policy, entitled Garbage and Rubbish Removal, dated 2020, document, 8. Outdoor trash receptacles will be kept covered and the surrounding area kept free of litter. Trash receptacles will be placed a pad that is cleanable and non-porous. On 03/26/2024, at 9:30 a.m., during the initial kitchen tour, with V6/Dietary Manager, the lid, to the steel trash receptacle, located outside, was left opened. Additionally, the area surrounding the trash receptacle was littered with cigarette butts. V6 confirmed the lid, to the trash receptacle, should have been closed and area free of debris. The Centers for Medicare and Medicaid Services form, entitled Long-Term Care Facility Application for Medicare and Medicaid, dated 3/26/2024, signed by V1/Administrator, document, 79 residents reside in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145486 If continuation sheet Page 14 of 14

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Citations

13 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0693GeneralS&S Dpotential for harm
F693 - Assisted nutrition and hydration
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0657GeneralS&S Dpotential for harm
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
0346GeneralS&S Fpotential for harm
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
0354GeneralS&S Fpotential for harm
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
0741GeneralS&S Fpotential for harm
F741 - The facility must have sufficient staff who provide direct services to
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
0920GeneralS&S Epotential for harm
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.
0814GeneralS&S Fpotential for harm
F814 - Food Safety Requirements
Dispose of garbage and refuse properly.
0351GeneralS&S Epotential for harm
Install an approved automatic sprinkler system.

FAQ · About this visit

Common questions about this visit

What happened during the March 29, 2024 survey of GOLDWATER CARE SPRING VALLEY?

This was a inspection survey of GOLDWATER CARE SPRING VALLEY on March 29, 2024. The surveyor cited 13 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at GOLDWATER CARE SPRING VALLEY on March 29, 2024?

Yes, 13 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be ..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

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Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·March 29, 2024