Westchester Harbour at Providence Place

The facility failed to ensure that 8 ounces of milk or equivalent dairy products were served three times daily to residents in the Special Care Unit. During meal services on January 7 and January 8, 2025, multiple residents were served only juice, tea, coffee, lemonade, or water without any dairy offered. Staff interviews indicated a lack of awareness regarding the requirement to serve milk with every meal.

The facility failed to ensure that 8 ounces of milk or equivalent dairy products were served three times daily to 14 of 23 residents in the Special Care Unit. Observations during meal service showed residents were served various beverages like juice, tea, and water, but milk or dairy alternatives were not provided to the identified residents.

The facility failed to ensure physician follow-up was completed for a resident who had orders to notify the primary care provider of weight gain of 3 pounds or greater in one day. Multiple instances of significant weight gain occurred between April and May 2023 without documentation that the physician was notified. This failure to follow medical orders resulted in the physician only learning of the resident's condition via a notification from a home health nurse.

The facility failed to ensure physician follow-up was completed for a resident who had an order for daily weights with specific parameters for notifying the doctor. Specifically, there was no documentation that the primary care provider was notified of multiple instances of weight gain exceeding 3 pounds within a single day during April and May 2023.

The facility failed to ensure physician notification and follow-up for several residents. Specifically, the facility did not notify the physician regarding a facial lesion and a dermatology referral for one resident, failed to follow up on an order for TED hose for another, and failed to follow up on an order for Vitamin B12 laboratory work for a third resident.

The facility failed to ensure physician notification and follow-up for several residents' health care needs. Specifically, staff failed to notify the physician regarding a facial lesion and a dermatology referral for one resident, failed to provide TED hoses for another, and failed to follow up on Vitamin B12 laboratory work for a third resident.

The facility failed to verify that one of six sampled staff members had no substantiated findings listed on the North Carolina Health Care Personnel Registry prior to employment. A review of the employee's file showed no documentation that a registry check had been completed before they were hired.

The facility failed to ensure that one of six sampled staff members was tested for Tuberculosis (TB) disease upon employment. Documentation showed a previous test from 2016, but no evidence of a required TB skin test was provided for the staff member's start date at the facility.

The facility failed to ensure that one out of six sampled staff members was tested for Tuberculosis (TB) disease upon employment. Specifically, a contracted Medication Aide lacked documentation of a TB skin test administered at the time they began working at the facility on 2/14/17.