Pike Creek Nursing & Rehabilitation Center

F 0550

permission to enter as a resident was currently in the room.

Level of Harm - Minimal harm or potential for actual harm

-8/6/25 11:43 AM - observed E14 (HA) knock, state housekeeping and entered another room without asking permission to enter as a resident was currently in the room.

Residents Affected - Some

-8/6/25 12:08 PM - observed E15 (CNA) respond to a triggered call light by walking into the room without knocking and asking permission to enter. -8/6/25 12:13 PM - observed E16 (HA) knock and walk into two residents' rooms in succession without asking permission to enter. -8/7/25 9:49 AM - observed E17 (contracted NP) walk into a resident's room without knocking and asking permission to enter. -8/7/25 10:20 AM - observed E18 (HA) knock, announce housekeeping and walk into a resident's room. 8/13/25 9:15 AM - During an interview, finding was reviewed with E3 (DON). Surveyor asked what is the expectation of staff before entering resident rooms, E3 stated that they should knock and ask permission

before entering. 8/13/25 3:00 PM - Findings were reviewed during the exit conference with E1 (NHA), E2 (RDCS), E3, E4 (ADON) and representatives with the management company, MC1 and MC2.

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Pike Creek Nursing & Rehabilitation Center

5651 Limestone Road Wilmington, DE 19808

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

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Based on record review and interview, it was determined that for two (Resident R22, Resident R153) out of 37 residents reviewed for care plans, the facility failed to develop a comprehensive person-centered care plan for each resident that addressed each resident's medical needs. Findings include:1. Resident R22’s clinical record revealed: 7/8/25 - Resident R22 was admitted to the facility with diagnoses that included, but were not limited to, a stroke, dysphagia and gastrostomy. 7/12/25 - Resident R22 was care planned for at risk for complications related to the need for an enteral tube feeding.

Review of the care plan lacked evidence of approaches for tube blockage and dislodgment. 8/13/25 8:00 AM - During an interview, E4 (ADON) was asked if Resident R22's care plan approaches addressed potential complications of gastrostomy tube blockage and dislodgment. E4 reviewed Resident R22's care plan and acknowledged that the care plan did not include these approaches.

1. 2. Resident R153’s clinical record revealed:

6/19/25 – Resident R153 was admitted to the facility with diagnoses that included, but were not limited to, lupus and chronic pain. Resident R153 had two care plans that addressed her pain, including:6/20/25 – Risk for pain related to recent hospitalization and recent fall at home; and 7/8/25 – OPIOIDS…at risk for complications. Resident R153’s pain care plans lacked evidence of non-pharmacological interventions for pain management. 8/13/25 9:15 AM – During an interview, finding was reviewed with E3 (DON).

No further information was provided to the surveyor prior to exit conference. 8/13/25 3:00 PM - Findings were reviewed during the exit conference with E1 (NHA), E2 (RDCS) and E3 (DON).

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Pike Creek Nursing & Rehabilitation Center

5651 Limestone Road Wilmington, DE 19808

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 0684 Level of Harm - Minimal harm or potential for actual harm

8/6/25 – A review of Resident R110’s hospice care plan revealed a stated focus, “The resident is receiving hospice services and is not expected to improve in condition for diagnosis of CHF (Chronic Heart Failure).” The goal was documented as, “The resident’s care needs will be met, and they will be as comfortable as possible through review period.” The intervention listed was, “See Hospice plan of care.”

Residents Affected - Few 8/6/25 11:00 AM – An interview with E32 (LPN) confirmed that nursing staff can access the hospice care plan in the resident’s hospice binder. 8/6/25 11:24 AM – The surveyor requested Resident R110’s hospice binder, which staff stated housed

the hospice plan of care. The binder was not available at the nurse’s station. When the binder was located, it was empty and contained no hospice plan of care. 8/6/25 12:25 PM – During an interview, E10 (LSW) stated, “That is usually found in the hospice binder.” E10 and the surveyor reviewed the hospice binder together, but no care plan documents were found. E10 then stated, “We use our own facility care plan, which should include

the hospice care plan.”

A review of Resident R110’s facility-generated comprehensive care plan revealed no evidence that the hospice plan of care had been incorporated into the resident’s care plan or that the facility collaborated with hospice staff to ensure the resident’s end-of-life needs and interventions were addressed. 8/6/25 12:40 PM – An interview with E3 (DON) confirmed the hospice plan of care was expected to be kept current and available in the hospice binder for staff reference. E3 stated, “The hospice nurses usually update the binder, and then we make changes as needed, but I see the binder is missing information, so that should have been addressed.”

The facility’s failure to ensure the hospice plan of care was available and integrated into the comprehensive care plan resulted in staff not having access to up-to-date goals and interventions for Resident R110’s hospice needs. 8/13/25 3:00 PM - Findings were reviewed during the exit conference with E1 (NHA), E2 (RDCS), and E3 (DON).

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Pike Creek Nursing & Rehabilitation Center

5651 Limestone Road Wilmington, DE 19808

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 0732

Post nurse staffing information every day.

Level of Harm - Potential for minimal harm

Based on observation and interview, it was determined that for eight out of eight days on survey, the facility failed to post nurse staffing information on a daily basis that included, but was not limited too, the resident census and the total number of hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift. Findings include:8/4/25 through 8/13/25 - Observation and review of the facility's daily nurse staffing posting lacked evidence of the resident daily census and the total number of hours worked by licensed and unlicensed nursing staff per shift. 8/13/2025 10:50 AM - During an interview, finding was reviewed with E1 (NHA). 8/13/25 at 3:00 PM - Finding was reviewed during the exit conference with E1, E2 (RDCS), E3 (DON), E4 (ADON) and representatives with the management company, MC1 and MC2.

Residents Affected - Many

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

Event ID:

Facility ID:

If continuation sheet