Nursing Home News — Page 1173

The facility's failure to ensure nursing staff possessed adequate infection control skills violates basic standards of care.

These violations occurred while the resident was watching television and eating meals, creating sustained exposure to potential contamination sources.

The damaged door exposed multiple construction nails with sharp points facing into the room.

One resident was observed lying in the same position from 10:08 a.m.

After returning from a February 2025 hospitalization, the resident should have received tacrolimus twice daily: 2 mg each morning at 9 A.M.

The tracking system used to monitor staff certifications was found to be incomplete, with columns for CPR issue dates and expiration dates left blank.

Inspectors documented water temperatures reaching **124 degrees Fahrenheit** in a shower room sink and **123.2 degrees Fahrenheit** in a resident room sink.

Federal surveyors found that weekly audits conducted by nurse managers from February through May 2025 were fundamentally flawed in their design and execution.

## Medical Significance of Dialysis Communication Protocols Proper dialysis care coordination represents a critical component of kidney failure treatment.

In the main kitchen area, investigators found several opened condiment containers without dates, including ketchup and other sauces.

The patient, who has paraplegia, seizure disorder, and dysphagia (difficulty swallowing), was found unresponsive and required a code blue emergency response.

## Medical Consequences of Inadequate Staff Training The absence of proper training creates multiple pathways for compromised resident care and safety.