Tabor Commons

The facility failed to provide personal care and hygiene assistance in accordance with the resident's care plan. Specifically, a resident was observed with hands soiled with a dried brown substance, and previous hospice notes indicated multiple instances of the resident having feces on her hands and food on her clothing.

The facility failed to provide personal care assistance in accordance with the resident's assessed needs and care plan for one resident. Specifically, staff failed to manage incontinence and hygiene, as evidenced by a hospice nurse finding the resident with feces on her hand and soiled briefs on multiple occasions.

The facility failed to provide residents with non-disposable place settings, including forks, knives, spoons, and cups, during meal service. Observations revealed residents eating meals from styrofoam to-go plates and using plastic utensils in their rooms. Staff confirmed it was standard practice to use disposable items for residents eating in their rooms despite having sufficient non-disposable supplies available.

The facility failed to provide residents with non-disposable place settings, including forks, knives, spoons, and cups, during meal service. Observations revealed residents eating meals from styrofoam plates and using plastic utensils in their rooms. Staff interviews confirmed that using disposable items for in-room dining had become a standard practice even after COVID-19 restrictions were lifted.

The facility failed to ensure foods were stored in a manner to prevent contamination. Specifically, opened food packages were not labeled or dated, a large bin containing sugar, flour, and cornmeal had a cracked cover, and meat was being thawed in a sink without cold running water.

The facility failed to ensure foods were stored in a manner to prevent contamination. Specifically, opened food packages like mayonnaise were not labeled or dated, and a bin containing sugar, flour, and cornmeal had a cracked cover. Additionally, meat was observed thawing in a sink without cold running water.

The facility failed to ensure the Primary Care Provider was contacted to clarify and document incomplete orders for sliding scale insulin for one resident. Specifically, the facility did not verify or document the clarification of orders regarding insulin administration based on blood glucose results.

The facility failed to ensure the Primary Care Provider was contacted to clarify and document incomplete orders for sliding scale insulin for one resident. Specifically, the facility did not verify or document the clarification of orders regarding insulin administration based on blood glucose results.