Abbotsford Health Care Center

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility did not update R1's care plan with new interventions and/or monitoring to prevent further potential elopements.

The facility practice had the potential to affect 1 of 3 residents (R) (R1) reviewed.

This was evidenced by the facility policy, titled Abuse, Neglect and Exploitation which states under section VII(A)(b): Defining how care provision will be changed and/or improved to protect residents receiving services. R1 was admitted to the facility on [DATE] under guardianship and with diagnoses that include benign neoplasm of meninges and mild cognitive impairment. R1's admission Minimum Data Set (MDS) indicated R1 has a BIMS of 7 (moderately impaired); displays wandering and frequency behavior of these type 1 to 3 days; uses a walker and wheelchair independently, R1's elopement evaluation completed on 07/02/25 indicates in part, R1 has a history of elopement or attempted leaving the facility without informing staff. R1's care plan initiated on 07/03/25 for Safety General/Smoker indicated that R1's guardian had given permission for R1 to go off premises to smoke as facility is a smoke-free facility.

On 07/22/25, the facility reported an incident wherein R1 independently contacted a transport van and left the premises without staff authorization to attend an eye appointment that R1's guardian had previously notified R1 the appointment was cancelled until prescription was verified.

Surveyor requested information from Director of Nursing (DON) B regarding interventions added to the care plan to ensure R1 is safe. DON B stated that guardian refuses wander guard, facility did notify Adult Protective Service and placed information into care plan regarding guardian's wishes of allowing resident to leave facility, but no new interventions/monitoring were put on the care plan to prevent this type of incident from reoccurring.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/29/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbotsford Health Care Center

600 E Elm St Abbotsford, WI 54405

SUMMARY STATEMENT OF DEFICIENCIES