The resident, who had dementia and exhibited physical behaviors, rejection of care, and wandering, began hospice services on January 17, 2025.
Nursing Home News — Page 934
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The **resident's precarious positioning created immediate risks for injury**.
The immediate jeopardy citation, classified at the highest severity level L, centered on failures in facility administration under federal regulation F688.
This meant the resident went 18 days without receiving the full prescribed dosage of their antipsychotic medication.
Despite the resident experiencing **multiple hospitalizations for dehydration**, staff failed to implement basic preventive measures.
The bruising documentation appeared again two weeks later.
Medical records showed the resident's weight began declining sharply in April, with an 8-pound loss in just one month between April and May.
The April 5 incident was particularly serious - an unwitnessed fall that resulted in a head laceration and emergency room evaluation.
However, documentation revealed a troubling lack of oversight.
The resident's care plan, initiated April 3, 2025, clearly documented a history of suicidal ideation and previous suicide attempts.
This violation affects multiple staff members and poses potential risks to resident safety.
These assessments directly influence the level of care residents receive and determine staffing needs for specific medical conditions.