Rocky Top Care Center
ROCKY TOP CARE CENTER in ROCKY TOP, TN — inspection on August 22, 2024.
Found 19 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
During an observation and interview on 8/12/2024 at 1:33 PM, The Activity Director entered the dining room with Resident #10's meal tray and stated Resident #10's lunch meal was in the resident's room on the bedside table and stated she was unsure who had left the meal in Resident #10's room.
The Activity Director confirmed Resident #10's meal tray was left in the resident's room and the resident was not served the meal in the dining room until 1:34 PM.
During an interview on 8/12/2024 at 1:50 PM, the Regional [NAME] President stated residents in the dining room were to be served one table at a time and confirmed the residents were not served timely for the lunch meal.
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Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
Review of the facility's policy titled, Residents Rights and Quality of Life, dated 5/1/2012, revealed, .all residents have the right to a dignified existence .with access to services inside and outside the facility .to receive services in a facility environment that is safe, clean and comfortable .
Review of the medical record revealed Resident #77 was admitted to the facility on [DATE] with diagnoses including Difficulty Walking, Weakness, and Lack of Coordination.
Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #77 scored a 7 on the Brief Interview for Mental for Status (BIMS) assessment which indicated the resident had severe cognitive impairment.
During observations in room [ROOM NUMBER] on 8/12/2024 at 11:00 AM; on 8/13/2024 at 2:45 PM; on 8/14/2024 at 1:35 PM; and on 8/20/2024 at 8:20 AM, revealed Resident #77's bathtub contained dead insects in the bottom of the bathtub with a brownish, black dirt-like substance around the drain.
During an observation and interview in room [ROOM NUMBER] on 8/20/2024 at 8:20 AM, with the Administrator, revealed Resident #77's bathtub contained dead insects in the bottom of the bathtub with a brownish, black dirt-like substance around the drain.
The Administrator confirmed Resident #77's bathtub had not been maintained in a sanitary manner and did not represent a clean, homelike environment for the resident.
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
During a telephone interview on 8/15/2024 at 9:25 AM, the Psych NP stated she was aware of the resident-to-resident altercation that occurred on 8/12/2024 between Resident #13 and #54.
The Psych NP stated immediate interventions were initiated and have been successful to prevent reoccurrence.
The Psych NP stated it is unknown if Resident #13 was triggered by Resident #54 due to the resident's cognition and considered this resident-to-resident altercation between Resident #13 and #54 an occurrence of physical abuse when Resident #13 hit Resident #54.
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
During an interview on 8/19/2024 at 9:52 AM, Resident #9 stated she was transported to the rescheduled urology appointment on 8/16/2024 by Medical Services and was evaluated by the urologist.
Review of the medical record revealed Resident #83 was admitted to the facility on [DATE] with diagnoses including Chronic Pain, Liver Disease, Heart Burn, and Abdominal Swelling.
Medical record review of the admission MDS assessment dated [DATE], revealed Resident #83 scored an 11 on the BIMS assessment which indicated the resident had moderate cognitive impairment.
Review of the Nurse Practitioner's (NP) note dated 7/22/2024, revealed the NP planned to discuss a stomach doctor consultation visit with the resident and resident's representative.
The appointment was to establish the resident with a specialist.
During an interview on 8/19/2024 at 3:00 PM, Resident #83 stated he had missed an appointment with a stomach doctor sometime this month (unsure of the exact date).
The resident stated a staff member had informed him the appointment was rescheduled and he was not informed why the appointment had been rescheduled.
The resident also stated the appointment was for him to become established with a different stomach doctor (due to a history of ascites from cirrhosis of the liver).
During an interview on 8/20/2024 at 8:30 AM, the Resident Appointment Scheduler stated she was hired at the facility .a couple of weeks ago . Resident #83 had a .stomach doctor . appointment scheduled for 8/13/2024.
The Resident Appointment Scheduler stated the day of Resident #83's appointment, she had rescheduled the appointment related to insufficient staff available to transport or assist Resident #83 to the appointment.
During an interview on 8/20/2024 at 8:41 AM, the Administrator stated Resident #83 had a doctor appointment scheduled on 8/13/2024, and confirmed the appointment was rescheduled related to insufficient staff available to transport or assist Resident #83 to the appointment.
During a telephone interview on 8/21/2024 at 10:19 AM, the Gastroenterology Associates office Appointment Scheduler stated Resident #83 had a consult appointment scheduled for 8/13/2024 and the resident was a .no show . for the appointment.
The facility called the Gastroenterology office and rescheduled a new consult appointment for 11/8/2024 at 12:30 PM for Resident #83.
During an interview on 8/22/2024 at 11:00 AM, NP W stated she was aware Resident #9 missed multiple urology visits and stated she was aware Resident #83 missed his stomach doctor appointment on 8/13/2024. NP W stated the rescheduled appointments were related to insufficient staff to provide the needed transportation or to assist the residents to their appointments. NP W also stated the missed appointments for Resident #9 and Resident #83 would not have caused harm or adverse effects to the residents.
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Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
During an interview on 8/14/2024 at 8:30 PM, CNA O stated CNA stated she was not always able to
During an interview on 8/20/2024 at 10:30 AM, the DNS confirmed baths were not being recorded as being completed or not.
Residents were not care planned as refusing bathing or showers and she was not aware of residents being out of the facility and unavailable. DNS confirmed that Resident #33 had only received from May 2024 - August 2024 3 out of 32 showers scheduled for resident.
Refer to F-725, F-835
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Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
During an interview on 8/20/2024 at 6:31 PM, The DNS and Administrator confirmed the facility failed to ensure the expected and appropriate level of staffing was scheduled and staff available in the facility to meet the resident care needs for showers and to provide transportation needs for outpatient physician appointments.
Refer to F-584, F-677, and F-842
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Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
Based on facility policy review, observation, and interviews the facility failed to ensure expired
observed.
The findings include: Review of the facility's policy titled, Medication Storage, revised 04/2022 revealed .the facility is responsible for maintaining proper storage .Expired .medications are immediately removed from stock and disposed .
During an observation and interview on 8/19/2024 at 6:35 PM, in the East medication room with Licensed Practical Nurse (LPN) F revealed the following expired supplies: 5 - 3 milliliter (mL) 25 gauge (ga) x (by) 1 inch syringe (device used to deliver medication into the muscle) with an expiration date of 11/8/2023 2 - Heparin Lock Flush Solution 5mL syringe with 500 USP (United States Pharmacopeia) units in 0.9% (percent) Normal Saline (medication administered into intravenous lines to prevent blood clots in the line) with an expiration date of 3/2024 1 - 3 mL 22 ga x 1 in syringe with an expiration date of 4/30/2024 46 - 10 mg (milligram) Bisacodyl suppositories (medication given rectally to promote a bowel movement) with an expiration date of 4/30/2024 12 - 3 mL 21 ga x 1 in syringe with an expiration date of 4/30/2024 40 - 650 mg Acetaminophen suppositories (medication given rectally to relieve pain or reduce a fever) with an expiration date of 7/2024.
LPN F confirmed a total of 18- 3 mL syringes, 86- suppositories, and 2- Heparin Lock Flushes were stored in the East medication room were expired and available for resident use.
During an interview on 8/20/2024 at 10:55 AM, The Director of Nursing Services (DNS) stated the expired medications and supplies should have been removed from the East medication storage room, placed into the pharmacy return bin, and discarded by the pharmacy.
The DNS also confirmed the total 18- 3 mL syringes, 86- suppositories, and 2- Heparin Lock Flushes were stored in the East medication room, were expired and available for resident use.
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
Review of the facility's policy titled, Team Member Sanitary Practices, dated 1/1/2017, revealed .center to promote guidelines for employee sanitary practices .wear hairnets or restraints .all hair including facial hair must be completely covered .
During an observation in the food preparation area on 8/12/2024 at 10:48 AM, with the Dietary Manager (DM), revealed 1 dietary aid without the presence of a protective beard covering to ensure all the facial hair was covered and contained.
During an interview on 8/12/2024 at 10:50 AM, the DM confirmed the dietary aid's beard was not fully covered in the food preparation area.
The DM stated all hair, including facial hair, should be covered while working in the kitchen.
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
Review of the facility's policy titled, Waste Control, dated 1/1/2012, revealed .it is the policy of this facility to store garbage and trash in a sanitary manner .dumpster must be kept closed at all times .
During an observation of the outside dumpster area on 8/12/2024 at 10:59 AM, with the Dietary Manager (DM), revealed 3 dumpsters for waste disposal.
Further observation revealed dumpsters A, B, and C had no drain plugs intact to the bottom corner of all 3 dumpsters, which left a golf-ball sized opening.
The missing dumpster plug to all three dumpsters left dumpster A, B, and C's contents open to the air, elements, and potential exposure to pests.
During an interview on 8/12/2024 at 11:00 AM, the DM confirmed the drain plugs for dumpsters A, B, and C were not intact and all three dumpster's contents were not contained properly.
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Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
jeopardy to resident health or safety Current employees are required to test twice a week during COVID-19 outbreak and as needed with development of any signs or symptoms (e.g., those with runny nose, cough, sneezing, shortness of
If current employee tests positive while at work, employee will notify Administrator, DNS, and/or ADNS (Assistant Director of Nursing Services), and the employee will be sent home immediately and will remain off work according to current CDC guidelines.
In the possibility of a staffing crisis, facility will initiate the following: Call all off duty staff including cross-trained staff Offer incentives Offer shift swaps or bonus day off Offer split shifts Call all licensed administrative staff that can come in and work under any capacity.
If above points unsuccessful involve Corporate Regional Support Team for further guidance.
An Ad Hoc QAPI meeting was conducted on 8/21/2024 with the Administrator, Director of Nursing Services, Director of Clinical Operations, Infection Preventionist, Minimum Data Set Coordinator, Director of Care Coordination and Medical Director to discuss, address, and review the deficient practice identified during the survey related to infection control practices and guidance to mitigate the spread of COVID-19 to staff and residents and infection control concerns identified with the handling of residents ' personal laundry.
All corrective actions will continue until a Plan of Correction is developed.
Refer to F-F835, F-F837, F-F867, and F-F880
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Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
jeopardy to resident health or safety Offer split shifts
If above points unsuccessful involve Corporate Regional Support Team for further guidance.
An Ad Hoc QAPI meeting was conducted on 8/21/2024 with the Administrator, Director of Nursing Services, Director of Clinical Operations, Infection Preventionist, Minimum Data Set Coordinator, Director of Care Coordination and Medical Director to discuss, address, and review the deficient practice identified during the survey related to infection control practices and guidance to mitigate the spread of COVID-19 to staff and residents and infection control concerns identified with the handling of residents ' personal laundry.
All corrective actions will continue until a Plan of Correction is developed Refer to F-F835, F-F837, F-F867, and F-F880
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
Review of the Facility Assessment Tool dated 7/28/2024, revealed the facility did not include the staffing parameters for the secure unit and contingency staffing protocol in response to emergency and crisis situations.
Further review revealed on 5/1/2024, the facility's laundry service had changed with new building modification plans to add an in-house laundry room which was not reflected in the facility's assessment.
Continued review revealed no documentation in the facility assessment that the facility allowed input from the direct-care staff, residents, or resident families regarding the needs and services provided by the facility.
During an interview on 8/20/2024 at 7:45 PM, the Administrator confirmed the secure unit staffing parameters, contingency staffing protocol in response emergency/crisis situations, building modification plans to add an in-house laundry room, change in the facility's laundry service, and documentation regarding the input from direct-care staff, residents, or resident families regarding the needs and services provided by the facility had not been reflected on the facility assessment dated [DATE].
Review of the facility ADL documentation for Resident #77, dated 8/1/2024-8/19/2024, revealed the
the ADL documentation revealed several days which were left blank or was documented as RNA or N/A.
During an interview on 8/14/2024 at 3:39 PM CNA B stated she provided care for Resident #77, regularly.
She stated the resident required total assistance with ADLs. CNA B stated she has seen him refuse showers but not often.
She stated low staffing had been an issue and out of her 3 12-hour shifts there were at least 2 days she was unable to provide the scheduled showers. CNA B further stated there were times the showers were completed but she did not have time to document them on the ADL record.
During an interview on 8/20/2024 at 10:18 AM, the DNS stated it was her expectation for residents to receive 2 scheduled showers per week.
The DNS reviewed Resident #33, #39, #49, and #77's ADL bathing records and confirmed the residents had not received the scheduled showers. DNS stated that some baths had not been documented in the medical record and felt like some holes were failure to chart which resulted in inaccurate medical record.
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
return to work after the following criteria have been met:
jeopardy to resident health or At least 7 days have passed since symptoms first appeared if a negative viral test is obtained within safety 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), and,
At least 24 hours have passed since last fever without the use of fever-reducing medications, and Symptoms (e.g., cough, shortness of breath) have improved.
Current employees are required to test twice a week during COVID-19 outbreak and as needed with development of any signs or symptoms (e.g., those with runny nose, cough, sneezing, shortness of breath).
If current employee tests positive while at work, employee will notify Administrator, DNS, and/or ADNS (Assistant Director of Nursing Services), and the employee will be sent home immediately and will remain off work according to current CDC guidelines.
In the possibility of a staffing crisis, facility will initiate the following: Call all off duty staff including cross-trained staff Offer incentives Offer shift swaps or bonus day off Offer split shifts Call all licensed administrative staff that can come in and work under any capacity.
If above points unsuccessful involve Corporate Regional Support Team for further guidance.
An Ad Hoc QAPI meeting was conducted on 8/21/2024 with the Administrator, DNS, Director of Clinical Operations, Infection Preventionist, Minimum Data Set Coordinator, Director of Care Coordination, and Medical Director to discuss, address, and review the deficient practice identified during the survey related to infection control practices and guidance to mitigate the spread of COVID-19 to staff and residents and infection control concerns identified with the handling of residents' personal laundry.
All corrective actions will continue until a Plan of Correction is developed.
Refer to F-F835, F-F837, F-F867, and F-F880
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
Review of the Nurse's Notes for Resident #36 dated 6/26/2024, revealed .Resident tested positive for
Review of the Physician's Orders for Resident #36 dated 6/26/2024, revealed .Molnupiravir .200 mg .Give 4 capsule by mouth two times a day for COVID for 5 days . 2f)
Review of the medical record revealed Resident #42 was admitted to the facility on [DATE] with diagnoses including Dementia, Muscle Weakness, Need for Assistance with Personal Care, and Difficulty Walking.
Review of the medical record revealed Resident #42 resided in room [ROOM NUMBER]A on the 300 Hallway at the time of the COVID-19 outbreak.
Review of an admission MDS assessment dated [DATE], revealed Resident #42 scored a 4 on the BIMS assessment which indicated the resident had severe cognitive impairment.
Review of the Nurse's Notes for Resident #42 dated 6/22/2024, revealed .Spoke with family .notified of positive C0vid 19 [COVID-19] test today .Resident Complains [complains] of feeling tired .
Review of the Physician's Orders for Resident #42 dated 6/24/2024, revealed .Molnupiravir .Give 4 capsule by mouth two times a day for COVID 19 for 5 Days . 2g)
Review of the medical record revealed Resident #46 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease, Dependence on Supplemental Oxygen, and Chronic Respiratory Failure.
Review of the medical record revealed Resident #46 resided in room [ROOM NUMBER]B on the 300 Hallway at the time of the COVID-19 outbreak.
Review of a quarterly MDS assessment dated [DATE], revealed Resident #46 scored a 15 on the BIMS assessment which indicated the reside[TRUNCATED]
445259 08/22/2024
Rocky Top Care Center 204 Industrial Park Rd Po Box 659 Rocky Top, TN 37769
During an interview on 8/14/2024 at 1:13 PM, the DNS stated she received voiced concerns from CNAs and nurses regarding low staffing and scheduled showers not being completed.
During an interview on 8/14/2024 at 3:00 PM, the Administrator stated he was aware the facility had some staffing concerns and stated, .I do know it [staffing concerns] exists .
The Administrator confirmed he was aware some of the residents had not received scheduled showers at times.
During an interview on 8/20/2024 at 6:31 PM, the DNS and the Administrator confirmed the facility failed to ensure the expected and sufficient level of staffing was available in the facility to meet all the resident care needs including the scheduled showers and transportation for scheduled outpatient physician appointments.
Refer to
During an interview on 8/20/2024 at 7:35 PM, the Administrator stated the facility had some areas of improvement to address regarding infection prevention and control practices and sufficient staffing provisions.
Validation of the Allegation of Compliance (AOC) Removal Plan to remove the immediacy of the Jeopardy (IJ) was conducted on 8/22/2024 through review of facility documentation, medical record reviews, and interviews.
On 8/20/2024, the Administrator and DNS were educated on Infection Control Policies, COVID-19 Guidelines from the Infection Control Manual and CDC Recommendations, Transmission Based Precautions, Enhanced Barrier Precautions, QAPI, and Handling Soiled Linen by Regional [NAME] President, Regional Director of Clinical Operations, and Senior Director of Clinical Quality and Education.
On 8/20/2024-8/21/2024, staff education was started by the DNS, or designee, with all staff on duty regarding isolation precautions for infection control including transmission- based precautions, hand hygiene, and enhanced barrier precautions, in-service on COVID-19 testing and guidelines related to safe care and prevention of COVID-19.
Employees will not be allowed to work until they have received this training.
The Administrator or designee will monitor the schedule to ensure no employee will work until their education has been completed.
445259
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 445259 B.
Wing 08/22/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Summit View of Rocky Top 204 Industrial Park Rd Rocky Top, TN 37769
During an interview on 8/20/2024 at 7:35 PM, the Administrator stated the facility had some areas of improvement to address regarding infection prevention and control practices.
Refer to F-835
Validation of the Allegation of Compliance (AOC) Removal Plan to remove the immediacy of the Jeopardy (IJ) was conducted on 8/22/2024 through review of facility documentation, medical record reviews, and interviews.
On 8/20/2024, the Administrator and DNS were educated on Infection Control Policies, COVID-19 Guidelines from the Infection Control Manual and CDC Recommendations, Transmission Based Precautions, Enhanced Barrier Precautions, QAPI, and Handling Soiled Linen by RVP, Regional Director of Clinical Operations, and Senior Director of Clinical Quality and Education.
On 8/20/2024-8/21/2024, staff education was started by the DNS, or designee, with all staff on duty regarding isolation precautions for infection control including transmission- based precautions, hand hygiene, and enhanced barrier precautions, in-service on COVID-19 testing and guidelines related to safe care and prevention of COVID-19.
Employees will not be allowed to work until they have received this training.
The Administrator or designee will monitor the schedule to ensure no employee will work until their education has been completed.
445259
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 445259 B.
Wing 08/22/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Summit View of Rocky Top 204 Industrial Park Rd Rocky Top, TN 37769
The facility failed to ensure COVID-19 positive employees were excluded from work for the required isolation time frame recommended by the CDC to control the exposure and spread of the COVID-19 virus during the facility's COVID-19 outbreak from 6/18/2024-8/7/2024 placing 22 residents (Resident #1, #2, #20, #33, #36, #42, #46, #53, #57, #71, #72, #78, #82, #340, #341, #3, #11, #27, #43, #12, #30, and #79) in an Immediate Jeopardy (IJ) situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.
The facility's failure to exclude COVID-19 positive employees from work had the potential to cause a serious adverse outcome for all 90 residents in the facility.
The facility failed to ensure 3 resident rooms (Resident #8, #39, and #60) had Enhanced Barrier Precautions (EBP) signage posted on the doors.
The facility census was 90.
The Administrator, Director of Nursing Services, Regional [NAME] President, and Regional Director of Clinical Operations Q were informed of the Immediate Jeopardy for F-880 on 8/20/2024 at 9:27 PM, in the Administrator's office.
The facility was cited IJ at F-880 at a scope and severity of L.
An Extended survey was conducted onsite from 8/20/2024 through 8/21/2024.
The IJ began on 5/1/2024 and continued through 8/21/2024.
The IJ ended on 8/21/2024 and was removed on site.
An acceptable removal plan, which removed the immediacy of the jeopardy, was provided by the facility on 8/21/2024 at 9:48 PM for F-880.
The corrective actions were validated onsite by the surveyors on 8/22/2024 for F-880.
Noncompliance continues at F-880 at a scope and severity of F.
The facility is required to submit a Plan of Correction (POC).
The findings include:
445259
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 445259 B.
Wing 08/22/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Summit View of Rocky Top 204 Industrial Park Rd Rocky Top, TN 37769
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.