Brookstone Haven

The facility failed to ensure health care reviews and follow-up for changes in resident conditions. Specifically, for Resident #5, the facility failed to monitor a scalp wound and follow orders to remove staples, resulting in one staple remaining in the resident's head long after the prescribed removal date.

The facility failed to ensure necessary health care follow-up for a resident who required staple removal from a scalp laceration. Although the ER discharge summary ordered the staples to be removed within seven days, an intact staple remained on the resident's head during the survey observation.

The facility failed to maintain the building and mechanical equipment in a safe and operating condition. Specifically, a heat/air conditioning unit in a resident's room was inoperable and physically damaged, with missing slats and gaps in the wall frame. This failure resulted in the resident being unable to maintain adequate warmth at night.

The facility failed to ensure a heat/air conditioning unit was operable and in good repair, resulting in a resident being cold at night. The unit had missing slats and a broken wood frame that allowed a view to the outside, and the unit was inoperable when turned on.

The facility failed to provide personal care and supervision according to the needs and frequency identified in residents' care plans. (Note: The provided text truncates during the description of this deficiency, but identifies the regulatory failure regarding care delivery).

The facility failed to ensure honey thickened liquids were prepared according to the manufacturer's instructions for three residents. Specifically, dietary staff were observed mixing thickener in 8-ounce cups using incorrect measurements compared to the required instructions for that volume.

The facility failed to ensure honey thickened liquids were prepared according to manufacturer instructions for three residents. Specifically, an 8-ounce cup of tea was prepared incorrectly, and a 6-ounce glass of water was served at a thin consistency despite orders for honey thickener. This failure to follow prescribed consistency creates a risk for aspiration.