Patapsco Healthcare

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

extremity) angiogram would be scheduled.In a Skin and Wound note, on 5/15/25 at 11:12 PM the NP wrote that the Resident #14 had a right lateral ankle arterial ulcer, his/her vascular consult was reviewed, and the resident would benefit from an angiogram, and an angiogram was to be scheduled. In a Nursing Progress Note on 5/16/25 at 6:41 PM, the nurse wrote Resident #14 had an appointment scheduled with a vascular specialist on 5/28/25 for a for a right lower angiogram-atherectomy-angioplasty-stent procedure.In an uploaded Wound & Amputation Prevention Consult note, on 5/28/25 at 11:55 AM, the physician documented a right lower extremity angiogram with intervention procedure was performed on Resident #14.On 5/28/25 at 3:16 PM, in an eMar Medication Administration Note, the nurse wrote that Resident #14 came back from vascular surgery at about 1:45 PM.Continued review of the medical record failed to reveal documentation to indicate Resident 14's representative had been notified when Resident #14 was scheduled for an outpatient appointment with a vascular specialist, or notified when the vascular specialist recommended and scheduled the resident for an angiogram with intervention, or notified when the resident completed the angiogram with intervention procedure and the outcome of the procedure.The above concerns were discussed with the Nursing Home Administrator (NHA) on 9/10/25 at 4:21 PM. The NHA acknowledged the concerns, and no further comments were offered at that time.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Patapsco Healthcare

9109 Liberty Road Randallstown, MD 21133

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 - Few

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

with the resident's current needs.Following the surveyor's review of the facility's self-report, a review of the facility's investigation documentation and a review of Resident #9's medical record revealed the facility failed to conduct a thorough investigation.1) Continued review of the facility's investigation documentation and Resident #9's medical record failed to reveal documentation to indicate a comprehensive assessment of Resident #9 had been completed when the injury to the resident had been identified and prior to sending him/her to the hospital. In addition, no documentation was found to indicate an assessment of other residents had been conducted.2) In the facility's initial report documented Staff #16, GNA reported the resident had poked him/herself in the eye. The investigation documentation included 3 GNA staff interviews.

Staff #16 documented the resident had poke him/herself in the eye, Staff #17, GNA documented the resident was observed with a wound on his/her left eye with a bump on his/her upper and lower eye, and Staff #18 GNA wrote that when s/he came on shift and saw the resident with an injury to his/her face and that Staff #16 told him/her that the resident had poked him/herself in the eye.Continued review of the facility's investigation documentation failed to reveal any other staff interviews, and there was no evidence that any residents had been interviewed or observed during the investigation.3) The facility report documented there were 2 GNA's who reported Resident #9's injuries were caused by a fall. The facility report failed to identify who were the GNAs who reported the fall, there were no statements from the GNA's, or evidence that staff interviews were conducted related to the fall. In addition, there was no documentation found to explain the discrepancy with the Staff #16, GNA's statement that Resident #9's injury was caused when the resident poked him/herself in the eye, as reported in the initial self-report and

the conclusion that the resident had fallen as reported in the final self-report. Review of Staff #16's employee file, found no documentation to indicate a discussion about the discrepancy with the employee's statement and the facility's conclusion that the resident's injury was related to a fall.In addition, there was no documentation in the medical record to corroborate the resident had fallen prior to his/her hospital transfer, and that after becoming aware of the fall, a comprehensive assessment had been completed on Resident #9.4) Review of Resident #9's MDS revealed a discharge return anticipated MDS on 3/15/25, Section GG, Functional abilities documented Resident #9 was non-ambulatory and dependent for positioning and transferring. Review of Resident #9's September 2025 physician orders revealed a 9/28/25 order, Handheld assist with ambulation, indicating the resident required someone to hold his/her hand to walk. Review of Resident #9's care plan revealed a fall care plan, initiated on 2/7/24 that included the intervention, Resident #9 will have hand-held assistance while out of bed and PT screening, initiated on 9/28/23. Review of Resident #9's Kardex reflected the resident required handheld assistance for ambulation.Continued review of the medical record failed to reveal evidence the facility staff implemented their intervention to ensure the care plan reflected an accurate status of Resident #9's care needs related to transfer and positioning, and failed to reveal evidence that the care plan was revised when there was a change in Resident #9's status, or with each MDS assessment.5) There was no evidence of staff abuse training or education of staff related to RAI documentation was found in the facility investigation documentation.During the surveyor's review of the facility's investigation of the Resident #9's injury, the concerns with the facility's documentation were discussed with the Nursing Home Administrator (NHA), who indicated when the incident occurred, different administration and clinical staff were working at the facility and he would look to see if there was missing documentation. On 8/11/25 at approximately 12:00 PM, the above concerns with failing to complete a thorough investigation were discussed with the NHA. The NHA acknowledged the concerns at that time, and stated no further facility investigation documents had been found.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Patapsco Healthcare

9109 Liberty Road Randallstown, MD 21133

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 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of pertinent documents and staff interviews, it was determined that the facility failed to ensure the discharge information was sufficiently documented in the medical record. This was evident for 1 (Resident #30) of 24 residents reviewed for a complaint during the complaint survey. The findings include:The MDS (Minimum Data Set) is a complete assessment of the resident which provides

the facility information necessary to develop a plan of care, provide the appropriate care and services to the resident, and to modify the care plan based on the resident's status. MDS assessments must be accurate to ensure that each Resident receives the care they need.On 9/8/25 at 12:00 PM, a review of complaint #299668 alleged on 10/26/24, the facility staff were asked to send Resident #30 to the emergency room because the resident's sacral wound had gotten worse. The complainant alleged that when s/he asked the nurse to send the Resident #30 to the hospital, the nurse said s/he had to call the physician, so the complainant called 911 and had the resident transported to the hospital where s/he was admitted for wound surgery.Review of the resident's closed electronic medical record (EMR) and closed paper medical record revealed Resident #30 was admitted to the facility in February 2024 with complex medical conditions, including pressure wounds, then transferred to the hospital in October 2024 and subsequently discharged from the facility. In an eMAR-Medication Administration Note, on 10/26/24 at 2:01 PM, the nurse documented that Resident #30 requested to go out 911 for wound assessment, and on 10/26/24 at 10:42 PM, in an eMAR-Medication Administration Note, the nurse documented that the outgoing nurse sent Resident #30 to the hospital wound evaluation.Resident #30's MDS discharge assessment, return anticipated, with an assessment date of 10/27/24 documented Resident #30 had an unplanned discharge

on [DATE REDACTED] and transferred to an acute hospital.Continued review of the medical record found no other documentation to indicate the reason for Resident #30's transfer to the hospital, and there was no documentation found to indicate a comprehensive assessment of Resident #30 had been completed prior to his/her transfer to the hospital. In addition, there was no documentation to indicate the physician had been made aware of Resident #30's request to go to the hospital, the resident's status and ultimate transfer to the hospital via 911.Further review of the medical record failed to reveal documentation to indicate that appropriate and necessary information, including a summary of the resident's status and the reason for the transfer, was communicated to the receiving health care institution to ensure a safe and effective transition of care. The medical record review failed to reveal evidence that prior to his/her transfer to the hospital, Resident #30 and his/her representative were notified of the transfer and the reasons for the move in writing and in a language and manner they understand, and there was no documentation to indicate at the time of the transfer, a written bed-hold notice which specified the duration of the bed-hold policy was provided to Resident #30. In addition to the above findings, no documentation was found to indicate that a discharge summary with a capitulation of the resident's stay had been completed by the resident's physician following the resident's transfer to the hospital and discharge from the facility.The above concerns were discussed with the Nursing Home Administrator on 9/10/25 at approximately 4:30 PM. NHA acknowledged the concerns and offered no further comments at that time.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Patapsco Healthcare

9109 Liberty Road Randallstown, MD 21133

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 0680

Ensure the activities program is directed by a qualified professional.

Level of Harm - Minimal harm or potential for actual harm

Based on facility staff roster and staff interview, it was determined that the facility failed to employ a qualified activities director from 10/2024 to 12/2024. This deficient practice was found during a complaint survey. The findings include: The surveyor reviewed intake # 299716 on 9/6/25 at 11:30am. The intake alleged that the facility failed to employ an activities director. The complainant stated that the last activities director left the facility in 10/2024. Interview with Activities Director #13 on 9/8/25 at 10:30am revealed that Activities Director #13 was hired in 12/2024. Interview with Unit Manager # 9 confirmed that the facility did not have an Activities Director in the month of 11/2024. On 9/10/25 at 10:06 AM, the surveyor interviewed

the Administrator regarding the staff in the activities department. The Administrator stated that the activities department has a activities director that will transfer to the social services department on 9/27/25. A new activities director is expected to start on the same day. The surveyor informed the Administrator that the activities department failed to have a qualified activities director from 10/2024 to 12/2024. The Administrator stated that he/she was not employed with the facility until 5/2025 and he/she was not aware of the deficient practice.

Residents Affected - Few

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Patapsco Healthcare

9109 Liberty Road Randallstown, MD 21133

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 0850

Hire a qualified full-time social worker in a facility with more than 120 beds.

Level of Harm - Minimal harm or potential for actual harm

Based on facility staff roster and staff interview, it was determined that the facility has a bed capacity of 160 and did not employ a qualified social worker from 4/2025 - 5/2025 and then again from 7/2025 to the present on a full-time basis. This deficient practice was found during a complaint survey. The findings include: Interview with the Regional Behavioral Analyst #10 on 9/8/25 at 12:50pm revealed that the facility's social work department does not have a current full-time qualified social worker. The last full-time qualified social worker left the position in 6/2025. Currently, Activities Director #13 assists with the social services tasks. Also, Regional Social Worker #11 supervises the social work tasks and assists as needed until a qualified full-time social worker director is hired. On 9/10/25 at 10:06 AM, the surveyor interviewed the Administrator regarding the staff in the social services department. The Administrator confirmed that the facility has not had a full-time qualified social worker since former social worker director #12 left in 6/2025.

The Administrator also added that the facility did not employ a full-time qualified social worker from 4/2025 5/2025. The Administrator also confirmed that Activities Director #13 and Regional Social Worker #11 assist with social service tasks as needed. The facility hired a new full-time social worker director who is expected to start on 9/15/25. The Administrator confirmed that the capacity of the facility is 160 beds. The surveyor expressed concerns that the facility failed to employ a full-time qualified social worker from 4/2025 - 5/2025 and then again from 7/2025 to the present.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet