Ketchikan Med Ctr New Horizons Transitional Care

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

remember. During an interview on 9/4/25 at 10:04 AM, the Director of Nursing stated it was not common practice to take personal belongings of residents and put them in staff desks. During an interview on 9/4/25 at 10:04 AM, the Chief Nursing Officer (CNO) stated she knew that the Administrator took Resident #16's checkbook and placed it in her desk, but she was not aware of how long the Administrator had the checkbook. The CNO stated it was not usual practice to keep personal belongings in personal desks. The CNO stated once she had heard Resident #16 was inquiring about his/her checkbook, she went into the Administrator's office and retrieved the checkbook from the Administrator's desk and it was returned to the resident. During an interview on 9/4/25 at 12:18 PM, Staff #45 stated he/she witnessed an interaction between the Administrator and Resident #16, after the Administrator had possession of the checkbook, where Resident #16 said, I want my checkbook! The Administrator dismissed Staff #45 saying, you don't need to be here for this, I got this. Staff #45 left the room. During an interview on 9/4/25 at 12:54 PM, Staff #62 stated he/she witnessed the initial interaction between the Administrator and Resident #16 concerning

the checkbook. Staff #62 stated his/her perspective of the conversation was that the Administrator was forcing Resident #16 to give up his/her checkbook and the words used by the Administrator were threatening saying, you don't really have a choice, you need to give me the checkbook. Staff #62 stated Resident #16 was mad. Staff #62 stated the Administrator dismissed him/her from the room prior to the conversation ending, and prior to the Administrator taking possession of the checkbook. Staff #62 was unaware of what transpired after being dismissed. During an interview on 9/4/25 at 12:58 PM, Resident #12's POA stated the Administrator called him/her about getting Resident #16's finances worked out for a payor source. The POA stated Resident #16's struggled with giving up control of his/her finances. The POA told the Administrator that he/she didn't force finances on residents, but if the facility wanted to help back him/her up, he/she felt it was in the resident's best interest to not have control of the finances. The POA further added, the Administrator stated she had no problem backing him/her up. Review of Resident #16's medical record revealed no notes regarding the Administrator's discussion with the POA, her interaction with Resident #16 to get the checkbook, that she stored the checkbook in her personal desk, or what the plan was going to be once she had the checkbook. Review of Resident #16's POA paperwork, dated 2/20/25, revealed the POA was named as Resident #16's agent with power under the category banking transactions. Review of the facility's policy LTC [Long Term Care]: Patient Rights and Responsibilities Policy, dated 1/10/25, revealed: It is the policy of PeaceHealth to define, recognize, protect and promote the rights and responsibilities of the patients and their legal, authorized or designated representatives . Review of the facility's Resident Rights and Responsibilities form, undated, which was available to all residents, revealed: . You have the right to dignity, respect and compassion. This includes your right to: Be treated with consideration, respect and dignity, recognizing reach resident's individuality . Exercise rights without interference, coercion,, discrimination, or reprisal; a homelike environment, and use personal belongings when possible . Keep personal belongings as space permits and have those possessions be kept safe .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

remember hearing that. During an interview on 9/4/25 at 1:14 PM, the Chief Nursing Officer (CNO) stated

she was in the 7/23/25 resident council meeting and confirmed the Administrator told the visitors they could not stay for the meeting. The CNO further stated that she witnessed several resident state that they wanted

the visitors to stay for the meeting. During an interview on 9/8/25 at 10:45 AM, Visitor #3 stated he/she was invited to the resident council meeting because he/she had heard some of the residents had concerns they wanted to voice, namely about activities. Visitor #3 stated when he/she got there, the Administrator stated

she didn't want the meeting to turn political, and Visitor #3 stated the Administrator asked him/her several times to not attend the meeting. Visitor #3 stated he/she left because he/she didn't want to disrupt the resident council meeting or cause a problem. Review of the facility's policy LTC [Long Term Care]: Patient Rights and Responsibilities Policy, dated 1/10/25, revealed: It is the policy of PeaceHealth to define, recognize, protect and promote the rights and responsibilities of the patients and their legal, authorized or designated representatives . Review of the facility's Resident Rights and Responsibilities form, undated, which was available to all residents, revealed: . You have the right to dignity, respect and compassion. This includes your right to: Be treated with consideration, respect and dignity, recognizing each resident's individuality . Exercise rights without interference, coercion, discrimination, or reprisal; You have the right to self-determination. This includes your right to . choice about designating a representative to exercise your rights; Organize and participate in resident and family group . You have the right to access to: Individuals, services, community members, and activities inside and outside the facility; Visitors of your choosing, at any time . Review of the facility policy LTC: Visitation Policy, dated 1/3/25, revealed: . The purpose of this policy is to define how the facility develops, implements, monitors, and evaluates visitation rights for applicable residents. The facility promotes visitation for all residents subject to the resident's wishes . Residents are permitted to have visitors of their choosing at the time of their choosing . Visitation will be resident-centered . Residents are permitted to visit with representatives from federal and state survey agencies, resident advocates . space and privacy are provided as needed for such visits . Review of the facility's policy LTC: Resident Council Meetings Policy, dated 1/10/25, revealed: The purpose of this policy is to promote empowerment of the residents and to provide opportunity for residents to have a voice regarding the Long Term Care Unit and the care that is being provided to them . Further review revealed no documentation that residents were permitted to invite visitors to the meetings as is their resident right.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0600

from abuse, neglect, exploitation and misappropriation of property .

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

a grievance committee and that all grievances were being addressed in the Quality Assurance and Performance Improvement (QAPI) committee. The Clinical Risk Manager stated that they were in the process of revamping the grievance committee, for a more robust and effective plan moving forward, and recognized there was room for improvement in this area. HR Department During an interview on 9/5/25 at 10:52 AM, the HR Director for PeaceHealth stated she was part of the 7/23/25 investigative process for the allegation of abuse by Resident #12. The HR Director for PeaceHealth stated the CNO had contacted her by phone, as she was out of state at the time, and the HR Director for PeaceHealth stated she provided verbal guidance and help to assist in placing the Administrator on administrative leave pending the investigation. When asked if to describe the guidance she provided, the HR Director for PeaceHealth stated

she wasn't involved in the investigation itself but did go over the CNO's findings after. When asked to explain what was discussed, the HR Director for PeaceHealth stated the CNO said she talked to the Administrator, talked with the residents and residents. When asked if the CNO went over the additional resident interviews during the discussion, the HR Director for PeaceHealth couldn't remember. When asked what the expectation would be for an investigation for an allegation of abuse would be, the HR Director for PeaceHealth stated she would expect documentation that included: 1) talk to any witnesses; 2) get to the bottom of what actually transpired; 3) interview the resident; 4) and interview the alleged perpetrator. When

the investigation documentation was reviewed with the HR Director for PeaceHealth, and what was not completed during the investigation, she acknowledged items were missing from the investigation. When asked if the CNO included her investigation documentation in the Safe2Share file, as indicated in the Safe2Share Electronic Reporting Policy, the Clinical Risk Manager stated, no. When asked who was responsible for the overall quality of a grievance investigation to ensure all grievance investigations were thoroughly completed and the investigation documentation met the facility's requirements, the HR Director for PeaceHealth stated they do not have any access to the Safe2Share system, and it was the department head who would be the leader of the investigation and not HR. The HR Director for PeaceHealth further stated they were not part of the QAPI committee. Review of the facility's policy Safe2Share Electronic Reporting Policy, dated 12/15/23, revealed: . It is the policy of PeaceHealth that caregivers and credentialed providers complete a Safe2Share report under the following circumstances: Upon any occurrence or event that involves a) an unsafe condition, b) an unanticipated outcome with respect to a patient care, c) a potential or actual unexpected or adverse outcome . Safe2Share is an important tool to support Clinical Excellence and Risk Management to help improve the provision of health care services[.] It is an integral part of that commitment is to maintain an awareness and improve situations that may present a risk of harm . Leadership Responsibility. Leaders of the primary department/unit named in the Safe2Share file are expected to review and investigate the submitted event, and document the investigation in the Safe2Share file . Network leadership is responsible to provide appropriate steps are taken to mitigate the harm or risk of harm, prevent further such events, to maintain patient safety, and respond to patient grievances . Risk Team members reviews Safe2Share files for completeness and additional routing .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** .Based on

record review and interview, the facility failed to report the results of an investigation of an allegation of abuse to the State Agency within 5 working days as required under CFR 483.12(c)(4). The lack reporting investigation results concerning an allegation of abuse in an appropriate and timely manner inhibited the State Agency from accurately assessing and investigating this allegation, which placed all residents (based

on a census of 26) at risk for future exposure to potential abuse. Findings:A facility reported incident (FRI) was submitted to the State Agency for an allegation of verbal abuse, dated 7/23/25, by the Chief Nursing Officer (CNO). During an interview on 9/3/25 at 1:34 PM, the CNO stated she faxed the final report to the State Agency on 8/4/25. When asked to show proof of this fax, the CNO stated she could not provide this proof. A review of the State Agency's fax line and email revealed no final report received from the facility for

the 7/23/25 incident. Review of an email received on 9/7/25, from the CNO, revealed: I was talking to . our HR Director Friday [9/5/25] after you guys headed to the airport. She triggered my brain to remember something regarding the final report that I could not prove that I had submitted. I did fax it to the state because on 7/28 I received a phone call from the state asking me to fill out the paperwork electronically for my final report. I am attaching the final report I saved because I wanted to ensure that I had proof of it .

Review of the email attachment revealed the report was an Adult Protective Services Intake Report. This report was dated 7/28/25 and labeled initial report. Further review revealed the detailed statement was identical to the initial report and contained no results from the investigation. Review of the facility policy LTC [Long Term Care]: State Reporting and Investigation of Suspected Abuse/Neglect of Resident and the Federal Elder Justice Act Policy, dated 2/18/25, revealed: . Reporting: In accordance with Alaska state law, 42CFR483.13(b)(c), all suspected cases of abuse and/or neglect will be reported as outlined below: Health Facilities Licensing and Certification (HFL&C): The initial reporting of the incident must be faxed or phoned immediately. Fax is the preferred method of contact; please fax (907) [PHONE NUMBER] or call (907) [PHONE NUMBER] for allegations including that involving nursing aide abuse. The results of the investigation must be followed up through a written report within five days of the initial reporting of the incident . Further review of the facility policy revealed the facility was also required to submit the initial report to the Division of Senior Services, which was where the Adult Protective Services Intake Reports would be generated. The policy stated: . it is not required to follow up with the Division of Senior Services with the results of the investigation .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

From these interviews, she determined these residents felt safe. When asked what the investigation's determination was, the CNO stated that because Resident #12 retracted his/her statement and because it was determined it was mainly about the Administrator's approach to communicating with others, she determined the abuse allegation as retracted and concluded the investigation on 7/28/25. The CNO stated

the Administrator returned to work on 7/29/25. Review of the facility's documentation of the resident interviews that occurred during this investigation, undated, revealed two resident's, Resident #20 and #25, interviews revealed they had felt verbally abused by the Administrator. During an interview on 9/3/25 at 1:34 PM, when asked if these comments were investigated, the CNO stated, no. Review of the facility policy Allegation of Abuse Policy, dated 12/15/24, revealed: . It is the policy of PeaceHealth that any allegation of abuse by a patient against a caregiver will be responded to immediately. An investigation of the facts will be coordinated . Caregiver - Patient Present. An allegation is made against a caregiver by a patient or another party for a patient currently in the hospital or in an ambulatory setting. Receiving Party. Any caregiver or provider who observes or who receives a report that anyone is being abusive, either physically, sexually, or verbally or in any way behaving in a manner harmful or disrespectful to any patient who is under the care of PeaceHealth, must immediately report this behavior to their manager/designee . Responding Leader. Visit

the patient to ensure they are safe and to advise the patient their concern is under review and who will be

the point of contact for the review going forward . Contact the risk manager on call . Contact their human resources partner to determine next steps with caregiver under review . the caregiver under review may be placed on administrative leave until the conclusion of the investigation . Contact the patient's provider .

Review of the facility policy Patient Complaint and Grievance Policy, dated 2/14/25, revealed: . This policy and procedure establishes a mechanism and the procedures to respond, review, and resolve patient grievances and complaints . Definitions . Grievance . Allegation of a patient rights violation, such as abuse, discrimination or violation of privacy rise to the level of a grievance . The process for responding to patient grievances according to federal regulations and regulatory guidelines is outlined in the Patient Complaint and Grievance Procedure . Patient Grievance Procedure . Leadership over the area where the grievance originated is responsible to initiate an immediate review, determine appropriate actions, and communicate findings in a timely manner investigation process will include . Interview all available witnesses identified by any sources as having personal knowledge of relevant to the complaint . Written report which includes the investigator's personal observation . A summary of all witness statements; and a statement of the basis for

the finding . Review of the facility's policy LTC [Long Term Care]: State Reporting and Investigation of Suspected Abuse/Neglect of Resident and the Federal Elder Justice Act Policy, dated 2/18/25, revealed: Procedure . Charge Nurse or 1st Responder . Immediately review the initial information. Determine immediately if the resident is in any danger of harm or further abuse . If the person alleged to be the abuser is a caregiver . immediately relieves them of duty . Begin preliminary investigation by speaking to the reporting person, addressing who did what when and, if known, why. When appropriate, briefly ask the resident/family what their thoughts are about the incident. Document findings on Investigation Report form .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

9/4/25 at 12:18 PM, Staff #71 stated that when floor and activities staff were talking about the 7/18/25 [NAME] Lake picnic outing, and how they would plan to bring Resident #5 and #9, who were diagnosed with dementia, Staff #71 stated the Administrator came out of her office and joined the conversation. The Administrator stated, Absolutely not and that these residents will never leave the unit. Staff #71 attempted to explain to the Administrator that these residents had routinely gone on outings, and done so safely, and it would not be appropriate to exclude them, however the Administrator would not agree. Staff #71 stated the residents could not go to the outing. During an interview on 9/4/25 at 1:14 PM, when asked if she had heard that residents with dementia diagnoses were not allowed to go on outings, the CNO stated she had heard this was a concern from staff, however, did not know enough about the federal regulations at the time. During an interview on 9/9/25 at 2:53 PM, the Medical Director stated that Resident #5 and #9 did have a history of wandering, however they had attended many outings in the past without concern, and

they would not need a 1:1 on outings. The Medical Director stated that caution was always needed, but there was no rule that these residents couldn't attend outings. Review of the facility's policy LTC [Long Term Care]: Activities Therapy Scope of Service, revised on 3/6/25, revealed: .Purpose. to provide appropriate daily activities for each resident. To comply with State and Federal regulations. Goals/Objectives. to provide meaningful and age appropriate activities that engage each resident while promoting dignity, respect and

the well-being of each resident. Provide one on one and group activities, special events, in house and outings to community events. Types of Residents. Early to advanced dementia including Alzheimer', illnesses of all body systems, end of life care, and wound care. Operation. Sunday-Saturday, open as needed to meet the needs of events for residents. Review of the facility's policy LTC: Resident Dignity Policy, revised 2/18/25, revealed: .The purpose of this policy is to provide the following, though not all inclusive, examples of maintaining resident dignity. In this context it means that in their interactions with residents, staff carries out activities that assist the resident to maintain and enhance his/her self-esteem and self-worth.c. Assist resident to attend activities of their choosing.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

about accurately coding ADL's such as bathing, dressing, eating, and toileting, which are critical for assessing a resident's functional status and support needs in LTC. It outlines objectives to define self-performance and support required for ADLs, code them correctly on the MDS (Minimum Data Set federally mandated assessment tool used in long-term care). Review of the facility training module Care of

the Resident with Mental Disorders, updated in 5/2023 revealed that the module aims to enhance caregivers' ability to support residents with behavioral health issues, focusing on identifying signs, symptoms, and triggers of these conditions, as well as specific strategies for improved communication with residents who have experienced trauma. It emphasizes the importance of trauma-informed care to mitigate triggers and ensure culturally competent care, aligning with regulatory standards that mandate facilities should eliminate or reduce abuse and provide care in accordance with residents' preferences and professional standards. Review of the facility training module QAPI Training for Caregivers, updated in 2023, revealed that the module aims to equip caregivers with the knowledge to contribute to QAPI by discussing how caregivers can participate, describing QAPI elements and tools, identifying regulatory mandates, and informing about available resources and supports. It emphasizes the importance of caregivers in all post-acute care settings in enhancing care quality through systematic improvement processes. Review of the facility training module Dementia-related Conditions - Resident Care PeaceHealth's Long Term Care Education, updated 5/2023, revealed that caregivers are encouraged to adopt a person-centered approach, recognizing stress triggers (physical, psychosocial, environmental) and using a four-step behavioral model (Prevent, Gather, A.C.T. [Ask, Collect, Treat], Redirect) to manage behaviors effectively. The module further trains caregivers with job specific behavioral models that include specific strategies such as preventing escalation with calm interactions, gathering information on resident preferences, and triggers. Review of the document Facility Assessment - Ketchikan Med [Center] New Horizons Transitional Care, dated 5/2024 indicated that total number of beds for the facility at the time of the assessment was 29. From this assessment, the residents that required assistance with ADLs, with specific needs included: bathing (20 residents), dressing (21), transferring (20 residents), toilet use (20 residents), and eating (20 residents). Behavioral health conditions or diagnoses were also identified in the facility assessment. The summary showed the most common conditions, and combinations of conditions that the facility may accept, such as dementia/impaired cognition (12 residents), depression (8 residents), anxiety disorders (4 residents), and others like schizophrenia (1 residents) and Post-traumatic stress disorder (1 residents)

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. .Based on record review and interview, the facility failed to ensure their facility assessment was reviewed and updated annually. This failed practice had the potential to place all residents (based on a census of 26) at risk of not having the necessary care and resources from an accurate assessment. Findings:Review of

the facility's Proactive LTC Consulting Facility Assessment revealed this assessment was last updated on 5/21/24. The Chief Nursing Officer (CNO) acknowledged this finding and stated the facility assessment needed to be updated

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ketchikan Med Ctr New Horizons Transitional Care

3100 Tongass Avenue Ketchikan, AK 99901

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 0947

exploitation

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet