Inspection Reports for Crestview Nursing & Residential Living
808 N. 8TH STREET, KS, 66538
Back to Facility ProfileInspection Report Summary
The most recent inspection on November 25, 2025, found no deficiencies and confirmed the facility was in compliance with all regulations. Earlier inspections showed some deficiencies primarily related to completing Functional Capacity Screens after changes in resident conditions and updating care plans to address specific health needs, as well as issues with vaccination documentation and safe mechanical lift transfers. Complaint investigations in the past identified lapses in resident supervision, including substantiated cases of elopement risk, but more recent reports do not list enforcement actions or fines. The facility has addressed prior deficiencies through plans of correction and subsequent revisits confirmed corrections were made. Inspection results indicate improvement over time, with the most recent surveys showing compliance and resolution of earlier cited issues.
Deficiencies (last 13 years)
Deficiencies (over 13 years)
7.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
25% worse than Kansas average
Kansas average: 6 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
6 residents
Based on a November 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Re-Inspection
Deficiencies: 0
Nov 25, 2025
Visit Reason
An offsite revisit survey was conducted to verify correction of all previous deficiencies cited on 2025-11-04.
Findings
All previously cited deficiencies have been corrected as of the compliance date 2025-11-18, and no new noncompliance was found. The facility is in compliance with all regulations surveyed.
Report Facts
Previous deficiencies cited: Deficiencies cited on 2025-11-04
Inspection Report
Re-Inspection
Census: 6
Deficiencies: 2
Nov 4, 2025
Visit Reason
The inspection was a Health Licensure Resurvey conducted to assess compliance with licensure requirements, specifically focusing on the completion of Functional Capacity Screens (FCS) for residents following changes in condition.
Findings
The facility failed to ensure designated staff completed Functional Capacity Screens for Residents 1 and 3 when they experienced changes in condition, including a compression fracture and a diagnosis of C-diff, respectively.
Severity Breakdown
SS = D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to complete Functional Capacity Screen for Resident 1 after a change in condition (compression fracture). | SS = D |
| Failure to complete Functional Capacity Screen for Resident 3 after a change in condition (C-diff diagnosis). | SS = D |
Report Facts
Census: 6
Residents in sample: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrative Nurse D | Administrative Nurse | Verified staff had not completed new Functional Capacity Screens for residents after changes in condition |
| Administrative Nurse E | Administrative Nurse | Responsible for completing Functional Capacity Screen forms for Residents 1 and 3 |
Inspection Report
Plan of Correction
Deficiencies: 0
Nov 4, 2025
Visit Reason
The document is a Plan of Correction submitted in response to findings from a Health Licensure Resurvey conducted at the facility on November 4, 2025.
Findings
The Plan of Correction addresses citations identified during the Health Licensure Resurvey on 11/4/25. Specific deficiencies are not detailed in this document.
Inspection Report
Follow-Up
Deficiencies: 0
Nov 20, 2024
Visit Reason
An offsite revisit survey was conducted on 11/20/24 to verify correction of all previous deficiencies cited on 10/24/24.
Findings
All deficiencies have been corrected as of the compliance date of 11/15/24, and no new noncompliance was found. The facility is in compliance with all regulations surveyed.
Report Facts
Previous deficiencies cited: 1
Inspection Report
Re-Inspection
Census: 23
Deficiencies: 3
Oct 24, 2024
Visit Reason
The inspection was a Health Resurvey to assess compliance with previously cited deficiencies and overall regulatory requirements.
Findings
The facility was found deficient in revising care plans to address PTSD triggers for a resident, ensuring safe mechanical lift transfers which resulted in a fractured finger for a resident, and failure to offer or document pneumococcal vaccination (PCV20) for eligible residents. Corrections were made for the mechanical lift deficiency prior to the survey.
Severity Breakdown
Level D: 2
Level G: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to revise the care plan for Resident 21 to provide direction to staff to eliminate or mitigate PTSD triggers, placing the resident at risk for impaired care. | Level D |
| Failure to ensure Resident 4 remained free from a preventable accident during a sit-to-stand mechanical lift transfer, resulting in a fractured finger. | Level G |
| Failure to offer or obtain informed declinations or physician-documented contraindications for the Pneumococcal Conjugate Vaccine (PCV20) for Residents 6, 8, and 21. | Level D |
Report Facts
Census: 23
Residents reviewed: 12
Residents reviewed for falls: 7
Residents reviewed for immunization status: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse G | Licensed Nurse | Interviewed regarding Resident 21's PTSD triggers and mechanical lift transfers. |
| Certified Nurse Aide M | Certified Nurse Aide | Interviewed regarding Resident 21's behaviors and mechanical lift training. |
| Social Service X | Social Service | Interviewed regarding Resident 21's PTSD and family communication. |
| Administrative Nurse D | Administrative Nurse | Interviewed regarding Resident 21's care plan, mechanical lift training, and immunization policies. |
| Consultant Staff GG | Consultant Staff | Interviewed regarding staff training on mechanical lifts. |
Inspection Report
Re-Inspection
Deficiencies: 0
May 9, 2024
Visit Reason
An offsite revisit survey was conducted to verify correction of all previous deficiencies cited on 2024-04-24.
Findings
All deficiencies have been corrected as of the compliance date of 2024-05-01, and no new noncompliance was found. The facility is in compliance with all regulations surveyed.
Report Facts
Previous deficiencies cited: 1
Inspection Report
Re-Inspection
Census: 6
Deficiencies: 4
Apr 24, 2024
Visit Reason
This document is a resurvey inspection conducted to evaluate compliance with regulatory requirements for a residential health care facility.
Findings
The facility failed to complete the Functional Capacity Screen (FCS) on or before admission for resident R101, and failed to develop or update Negotiated Service Agreements (NSA) based on the FCS and service needs for residents R101, R102, and R103. Additionally, the NSA did not identify the licensed nurse responsible for health care service implementation and supervision for residents R102 and R103.
Severity Breakdown
SS=D: 2
SS=E: 2
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to complete Functional Capacity Screen on or before admission for resident R101. | SS=D |
| Failure to fully develop Negotiated Service Agreement based on Functional Capacity Screen, service needs, and preferences for residents R101, R102, and R103. | SS=E |
| Failure to develop initial Negotiated Service Agreement at admission for resident R101. | SS=D |
| Failure to include the name of the licensed nurse responsible for implementation and supervision of health care services in the Negotiated Service Agreement for residents R102 and R103. | SS=E |
Report Facts
Census: 6
Sample size: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse C | Licensed Nurse | Acknowledged deficiencies related to NSA and FCS for residents R101, R102, and R103 |
| Administrative Staff B | Administrative Staff | Stated that R101's Functional Capacity Screen was not completed due to changes in staff responsibilities |
Inspection Report
Plan of Correction
Deficiencies: 0
Apr 24, 2024
Visit Reason
This document represents the findings of a resurvey conducted at a Residential Health Care facility on 04/24/24.
Findings
The document is a Plan of Correction submitted in response to the resurvey findings for the facility conducted on 04/24/24.
Inspection Report
Annual Inspection
Deficiencies: 0
Apr 19, 2023
Visit Reason
The health survey was conducted as an annual inspection to assess compliance with applicable regulations under 42 CFR Part 483, Subpart B, for long term care facilities.
Findings
The survey resulted in no deficiency citations, indicating full compliance with the regulatory requirements for long term care facilities.
Inspection Report
Plan of Correction
Deficiencies: 0
Apr 19, 2023
Visit Reason
The document is a Plan of Correction submitted in response to a health survey conducted at Crestview Nursing facility on April 19, 2023.
Findings
The health survey resulted in no deficiency citations with respect to applicable regulations under 42 CFR Part 483, Subpart B, for long term care facilities.
Inspection Report
Follow-Up
Deficiencies: 0
Jan 3, 2023
Visit Reason
An offsite revisit survey was conducted to verify correction of all previous deficiencies cited on 12/13/2022.
Findings
All deficiencies have been corrected as of the compliance date of 12/20/2022 and no new noncompliance was found. The facility is in compliance with all regulations surveyed.
Inspection Report
Re-Inspection
Census: 6
Deficiencies: 6
Dec 13, 2022
Visit Reason
This is a resurvey inspection conducted to verify compliance with previously identified deficiencies at Crestview Nursing & Residential Living.
Findings
The inspection found multiple deficiencies including failure to fully develop negotiated service agreements based on functional capacity screenings for residents, failure to identify licensed nurses responsible for health care service plans, incomplete documentation of medication administration responsibilities, incomplete employee records regarding nurse aide registry verification, lack of quarterly emergency management plan reviews with staff, and failure to ensure food storage temperatures were consistently monitored and documented.
Severity Breakdown
F: 5
D: 1
Deficiencies (6)
| Description | Severity |
|---|---|
| Failure to ensure the Negotiated Service Agreement (NSA) was fully developed based on the Functional Capacity Screen for residents R101, R102, and R103. | F |
| Failure to ensure the NSA identified the licensed nurse responsible for implementation and supervision of the health care services plan for residents R101, R102, and R103. | F |
| Failure to ensure the NSA reflected administration and management responsibilities for selected medications, including self-administered eye drops for resident R101. | D |
| Failure to ensure employee records included timely verification with the nurse aide registry for four of five newly hired employees. | F |
| Failure to ensure quarterly review of the emergency management plan was performed with employees. | F |
| Failure to ensure food items were stored under safe and sanitary conditions, including lack of consistent refrigerator temperature monitoring and documentation. | F |
Report Facts
Census: 6
Residents in sample: 3
Missing refrigerator temperature log dates: 21
Inspection Report
Plan of Correction
Deficiencies: 0
Dec 13, 2022
Visit Reason
This document represents the findings of a resurvey conducted for the Residential Health Care Facility on 12/13/22.
Findings
The document is a plan of correction submitted in response to the resurvey findings for the facility conducted on 12/13/22.
Inspection Report
Re-Inspection
Deficiencies: 0
Dec 17, 2021
Visit Reason
An offsite revisit survey was conducted on 12/17/21 for all previous deficiencies cited on 11/04/21.
Findings
All deficiencies have been corrected as of the compliance date of 12/02/21 and no new noncompliance was found. The facility is in compliance with all regulations surveyed.
Inspection Report
Re-Inspection
Census: 23
Deficiencies: 3
Nov 4, 2021
Visit Reason
The inspection was a Health Resurvey conducted to assess compliance with previously cited deficiencies and regulatory requirements.
Findings
The facility was found deficient in labeling and storing drugs properly, maintaining sanitary food storage and preparation conditions, and adhering to infection prevention and control protocols, including improper handling of resident water and ice passes and failure to disinfect glucometers between uses.
Severity Breakdown
SS=D: 1
SS=F: 1
SS=E: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to label Resident 9's insulin pen with date opened. | SS=D |
| Failed to store, prepare, and serve food under sanitary conditions, including expired and unlabeled food items and improper storage of heavy cream next to raw meat. | SS=F |
| Failed to maintain infection control principles during resident fresh water and ice pass and glucometer use. | SS=E |
Report Facts
Census: 23
Sample size: 12
Expired food items: 40
Expired food items: 3
Expired food items: 20
Unlabeled food items: 10
Unlabeled food items: 4
Ice build-up: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse G | Licensed Nurse | Verified Resident 9's insulin pen lacked date opened and failed to disinfect glucometer between uses. |
| Administrative Nurse E | Administrative Nurse | Stated nurses were to date insulin pens when opened and verified glucometer cleaning procedures. |
| Dietary Staff BB | Dietary Staff | Verified out of date and unlabeled foods should have been discarded and improper storage of heavy cream. |
| Administrative Nurse D | Administrative Nurse | Verified staff should not hold used water mugs over ice bin or touch scoop to inside of mugs. |
| Certified Nurse Aide M | Certified Nurse Aide | Observed holding resident's used water mugs over ice when filling. |
| Certified Nurse Aide N | Certified Nurse Aide | Observed holding resident's used water mugs over ice and tapping inside of mug with ice scoop. |
Inspection Report
Abbreviated Survey
Deficiencies: 0
Dec 8, 2020
Visit Reason
A Targeted Infection Control Survey/COVID-19 Focused Survey was conducted to assess the facility's compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Plan of Correction
Deficiencies: 0
Dec 8, 2020
Visit Reason
A Targeted Infection Control Survey/COVID-19 Focused Survey was conducted by KDADS on behalf of the Centers for Medicare & Medicaid Services (CMS) on 12/08/2020.
Findings
The facility was found to be in compliance with CMS and Centers for Disease Control and Prevention (CDC) recommended practices to prepare for COVID-19.
Inspection Report
Renewal
Deficiencies: 0
Aug 25, 2020
Visit Reason
The licensure resurvey of the assisted living facility was conducted to assess compliance and determine if any deficiency citations were warranted.
Findings
The licensure resurvey resulted in findings of no deficiency citations, indicating full compliance with regulatory requirements.
Inspection Report
Routine
Deficiencies: 0
Jul 23, 2020
Visit Reason
The special infection control survey for COVID-19 was conducted at the facility on 07/23/2020.
Findings
The survey resulted in findings of no deficiency citations.
Inspection Report
Routine
Census: 23
Deficiencies: 0
Jun 30, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) to assess compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Plan of Correction
Deficiencies: 0
Jun 30, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) on June 30, 2020.
Findings
The facility was found to be in compliance with CMS and Centers for Disease Control and Prevention (CDC) recommended practices to prepare for COVID-19.
Inspection Report
Annual Inspection
Deficiencies: 0
Jan 22, 2020
Visit Reason
The health survey was conducted as a regulatory inspection to assess compliance with applicable regulations under 42 CFR Part 483, Subpart B, for long term care facilities.
Findings
The survey resulted in a finding of no deficiency citations with respect to applicable regulations.
Inspection Report
Plan of Correction
Deficiencies: 0
Jan 22, 2020
Visit Reason
The document is a Plan of Correction submitted in response to a health survey of the facility.
Findings
The health survey resulted in a finding of no deficiency citations with respect to applicable regulations under 42 CFR Part 483, Subpart B, for long term care facilities.
Inspection Report
Plan of Correction
Deficiencies: 0
Jan 14, 2019
Visit Reason
The Health Resurvey and Complaint Investigation #KS00129327 was conducted for the facility.
Findings
The investigation resulted in a finding of no deficiency citations with respect to applicable regulations under 42 CFR Part 483, Subpart B, requirements for long term care facilities.
Inspection Report
Complaint Investigation
Deficiencies: 0
Jan 14, 2019
Visit Reason
The visit was conducted as a Licensure Resurvey and Complaint Investigation #KS00129327 of the facility.
Findings
The investigation resulted in a finding of no deficiency citations with respect to applicable regulations under 42 CFR Part 483, Subpart B, requirements for long term care facilities.
Complaint Details
Complaint Investigation #KS00129327 was conducted and found no deficiencies.
Inspection Report
Renewal
Deficiencies: 0
Feb 28, 2018
Visit Reason
The licensure resurvey of the assisted living facility was conducted on 2018-02-27 and 2018-02-28 to assess compliance for renewal of licensure.
Findings
The licensure resurvey resulted in findings of no deficiency citations.
Inspection Report
Re-Inspection
Deficiencies: 0
Feb 8, 2018
Visit Reason
An offsite revisit survey was conducted on 02/08/2018 for all previous deficiencies cited on 10/17/2017.
Findings
All deficiencies have been corrected as of the compliance date of 10/30/2017, and no new noncompliance was found. The facility is in compliance with all regulations surveyed.
Inspection Report
Plan of Correction
Deficiencies: 1
Oct 30, 2017
Visit Reason
This document is a Plan of Correction submitted by Crestview Nursing and Residential in response to deficiencies cited during a prior survey.
Findings
The plan addresses deficiencies related to infection control, including education and competency checks for housekeeping and nursing staff to prevent cross contamination and maintain standard infection control techniques. The facility aims to achieve substantial compliance by October 31, 2017.
Deficiencies (1)
| Description |
|---|
| Deficiencies cited related to infection control requiring education and competency checks for staff. |
Report Facts
Complete Date: Oct 30, 2017
Inspection Report
Re-Inspection
Deficiencies: 1
Oct 17, 2017
Visit Reason
A Health survey was conducted to determine if the facility was in compliance with Federal participation requirements for nursing homes participating in Medicare and/or Medicaid programs.
Findings
The survey found a most serious deficiency at level 'F', widespread, constituting no actual harm but with potential for more than minimal harm that is not immediate jeopardy. The facility submitted a plan of correction which was accepted, and the facility was found to be in substantial compliance effective 10/30/2017.
Severity Breakdown
F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Most serious deficiency was a 'F' level deficiency, widespread, constituting no actual harm with potential for more than minimal harm that is not immediate jeopardy. | F |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lacey Hunter | Licensing and Certification Enforcement Manager | Named as contact and signatory related to enforcement and survey findings. |
Inspection Report
Re-Inspection
Census: 31
Deficiencies: 3
Oct 17, 2017
Visit Reason
The inspection was a Health Resurvey to assess compliance with infection control and sanitation standards following previous findings.
Findings
The facility failed to effectively clean and sanitize resident rooms and equipment, including improper handling of reusable glucose testing equipment, failure to use clean barriers during dressing changes, and inadequate cleaning procedures by housekeeping staff, particularly not adhering to disinfectant wet time requirements.
Severity Breakdown
SS=F: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to adhere to standard infection control precautions regarding reusable equipment to prevent disease transmission. | SS=F |
| Failure to adhere to standard infection control precautions during dressing changes. | SS=F |
| Failure to clean residents' rooms and reusable equipment in a sanitary manner, including improper disinfectant use. | SS=F |
Report Facts
Resident census: 31
Disinfectant wet time: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed nursing staff H | Observed improperly handling glucose testing equipment and dressing changes. | |
| Administrative nursing staff E | Stated expectations for use of clean barriers during glucose testing and dressing changes. | |
| Housekeeping staff I | Observed cleaning resident rooms improperly and not adhering to disinfectant wet time. | |
| Housekeeping supervisor J | Confirmed disinfectant wet time requirement and lack of staff knowledge. | |
| Administrative staff A | Confirmed housekeeping training and failure to adhere to disinfectant wet time. | |
| Administrative staff B | Confirmed housekeeping training. | |
| Administrative nursing staff D | Expected adherence to disinfectant use recommendations and cleaning of high-use resident items. |
Inspection Report
Follow-Up
Deficiencies: 1
Aug 1, 2017
Visit Reason
This post-certification revisit was conducted to verify that previously reported deficiencies on the CMS-2567 Statement of Deficiencies and Plan of Correction have been corrected.
Findings
The revisit confirmed that the previously cited deficiency with ID Prefix F0278 related to regulation 483.20(g)-(j) was corrected as of 08/01/2017. No other deficiencies or uncorrected issues were noted.
Deficiencies (1)
| Description |
|---|
| Deficiency with ID Prefix F0278 related to regulation 483.20(g)-(j) |
Inspection Report
Census: 29
Deficiencies: 1
Jul 20, 2017
Visit Reason
The survey was conducted as an MDS (minimum data set) Focus Survey to assess the accuracy and coordination of resident assessments.
Findings
The facility failed to accurately code intermittent catheterization for resident #7 in multiple MDS assessments, including the 10/26/16 annual MDS and subsequent quarterly assessments. This deficiency involved failure to reflect the resident's use of intermittent catheterization in the bowel and bladder section of the MDS.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to accurately code intermittent catheterization in resident #7's MDS assessments. | SS=D |
Report Facts
Census: 29
Residents sampled: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nurse G | Licensed Nurse | Verified nurses performed intermittent catheterizations daily for resident #7 |
| Nurse D | Administrative Nurse | Checked MDS assessments for completion and indicated Nurse E completed and documented the assessments |
| Nurse E | Administrative Nurse | Completed the MDS assessments for resident #7 and verified assessments should include intermittent catheterization |
Inspection Report
Plan of Correction
Deficiencies: 1
Jul 20, 2017
Visit Reason
This document is a Plan of Correction submitted in response to deficiencies cited during a prior survey of the facility.
Findings
The facility acknowledged deficiencies related to the accuracy of Minimum Data Set (MDS) coding and outlined corrective actions including staff education, modification of the resident's MDS, and implementation of monitoring and quality assurance processes to ensure compliance.
Severity Breakdown
D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Deficiencies related to MDS coding accuracy and compliance with federal Medicare and Medicaid requirements. | D |
Report Facts
Complete Date for Plan of Correction: Aug 1, 2017
Inspection Report
Re-Inspection
Deficiencies: 1
Jul 20, 2017
Visit Reason
An MDS survey was conducted to determine if the facility is in compliance with Federal participation requirements for nursing homes participating in Medicare and/or Medicaid programs.
Findings
The survey found a single isolated 'D' level deficiency indicating no actual harm but with potential for more than minimal harm that is not immediate jeopardy. The facility submitted a plan of correction which was accepted, and the facility was found to be in substantial compliance effective August 1, 2017.
Severity Breakdown
D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| A 'D' level deficiency, isolated, constituting no actual harm with potential for more than minimal harm that is not immediate jeopardy. | D |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Irina Strakhova | Licensure Certification & Enforcement Manager | Named as the signatory and contact person for the inspection report. |
Inspection Report
Enforcement
Deficiencies: 1
Dec 4, 2015
Visit Reason
A Health survey was conducted on December 4, 2015, to determine if the facility was in compliance with Federal participation requirements for nursing homes participating in Medicare and/or Medicaid programs.
Findings
The survey found that the facility was not in substantial compliance with participation requirements, constituting past non-compliance to resident health or safety from September 4 through September 8, 2015. Based on these deficiencies and prior non-compliance history, enforcement remedies will be imposed without an opportunity for correction.
Deficiencies (1)
| Description |
|---|
| Facility was not in substantial compliance with participation requirements, constituting past non-compliance to resident health or safety from September 4 through September 8, 2015 for F323"J", CFR 01-483.25(h). |
Report Facts
Date range of non-compliance: September 4, 2015 through September 8, 2015
Previous survey date: August 21, 2014
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Irina Strakhova | Enforcement Coordinator | Signed letter regarding enforcement remedies |
| Sara Sourk | Administrator | Administrator of the facility named in the report |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 1
Dec 4, 2015
Visit Reason
The inspection was conducted as a Health Resurvey and Complaint Investigations #KS00089155 and KS00091323, triggered by concerns related to resident supervision and safety.
Findings
The facility failed to provide adequate supervision for a cognitively impaired resident (#20) who eloped from the facility and was found approximately 12 blocks away, placing the resident in immediate jeopardy. The investigation revealed lapses in staff response to door alarms and monitoring of residents at risk for elopement.
Complaint Details
The complaint investigation found that resident #20, with severe cognitive impairment and dementia, exited the facility without staff knowledge and was found 12 blocks away. Staff failed to properly respond to door alarms and monitor the resident, resulting in immediate jeopardy to the resident's safety.
Severity Breakdown
Immediate Jeopardy: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide adequate supervision of a resident at risk for elopement who left the facility unattended and was found 12 blocks away. | Immediate Jeopardy |
Report Facts
Resident census: 28
Resident elopement duration: 17
Distance resident eloped: 12
Fall Risk Assessment score: 11
Temperature: 91.9
Heat index: 96.9
Wind speed: 13.8
Inspection Report
Plan of Correction
Deficiencies: 0
Dec 4, 2015
Visit Reason
The document is a Plan of Correction addressing findings from a Health Resurvey and Complaint Investigations #KS00089155 and KS00091323.
Findings
The Plan of Correction corresponds to deficiencies identified during a Health Resurvey and Complaint Investigations, but specific findings are not detailed in this document.
Inspection Report
Re-Inspection
Deficiencies: 0
Dec 2, 2015
Visit Reason
The Assisted Living/Residential Healthcare resurvey of the facility was conducted to verify compliance and check for deficiencies.
Findings
The resurvey resulted in a finding of no deficiency citations.
Inspection Report
Life Safety
Deficiencies: 1
Aug 4, 2015
Visit Reason
A Life Safety Code survey was conducted by the State Fire Marshal's Office to determine if the facility was in compliance with Federal requirements for nursing homes participating in Medicare and/or Medicaid programs.
Findings
The survey found the most serious deficiencies to be an "F" level deficiency, widespread, with no harm but with potential for more than minimal harm that is not immediate jeopardy.
Severity Breakdown
F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Most serious deficiencies found were an "F" level deficiency, widespread, with no harm but potential for more than minimal harm that is not immediate jeopardy. | F |
Report Facts
Denial of payments effective date: Nov 4, 2015
Provider agreement termination date: Feb 4, 2016
Plan of Correction submission timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Irina Strakhova | Enforcement Coordinator | Signed the enforcement letter and coordinated the survey results. |
| Brenda McNorton | Director of Fire Prevention Division | Contact person for Informal Dispute Resolution process. |
Inspection Report
Follow-Up
Deficiencies: 1
Feb 20, 2015
Visit Reason
This is a post-certification revisit to verify that previously cited deficiencies have been corrected as of the revisit date.
Findings
The report confirms that the deficiency identified under regulation 483.13(c)(1)(ii)-(iii), (c)(2)-(4) was corrected by 02/20/2015.
Deficiencies (1)
| Description |
|---|
| Deficiency related to regulation 483.13(c)(1)(ii)-(iii), (c)(2)-(4) |
Report Facts
Deficiency correction date: Feb 20, 2015
Inspection Report
Plan of Correction
Deficiencies: 1
Feb 8, 2015
Visit Reason
This document is a Plan of Correction submitted by Crestview Nursing in response to deficiencies cited during a complaint investigation survey.
Findings
The facility acknowledged deficiencies related to failure to report a resident's fall allegations to the state agency and has developed a facility-wide system to ensure compliance with reporting requirements and regulations.
Complaint Details
The visit was complaint-related, triggered by a resident's fall and allegations. The facility found no malice but acknowledged failure to report the incident to the state agency. Staff were inserviced to prevent recurrence. The plan aims to ensure substantial compliance by February 20, 2015.
Severity Breakdown
D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report resident fall allegations to the state agency as required. | D |
Report Facts
Complete Date for Plan of Correction: Feb 20, 2015
Inspection Report
Abbreviated Survey
Deficiencies: 1
Jan 29, 2015
Visit Reason
An abbreviated survey was conducted to determine if the facility is in compliance with Federal participation requirements for nursing homes participating in the Medicare and/or Medicaid program.
Findings
The survey found a 'D' level deficiency indicating no actual harm but with potential for more than minimal harm that is not immediate jeopardy. The facility submitted a plan of correction which was accepted, and the facility was found to be in substantial compliance based on the credible allegation of compliance.
Severity Breakdown
D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Deficiency rated as 'D' level indicating no actual harm with potential for more than minimal harm that is not immediate jeopardy. | D |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary Jane Kennedy | Complaint Coordinator | Named as the contact person for questions concerning the survey information. |
Inspection Report
Complaint Investigation
Census: 27
Deficiencies: 1
Jan 29, 2015
Visit Reason
The inspection was conducted as a complaint investigation (#83503) regarding allegations of staff abuse and failure to properly investigate and report the incident involving a resident who experienced a fall resulting in a fractured hip.
Findings
The facility failed to investigate and report to the state agency an incident where a resident fell and sustained a fractured hip requiring surgery, and alleged staff abuse. The facility reported the incident to Adult Protective Services but did not notify the state agency as required, and administrative staff only became aware of the abuse allegations approximately 8 days after the incident.
Complaint Details
The complaint investigation (#83503) was substantiated as the facility failed to report the alleged staff abuse to the state agency in a timely manner and did not properly investigate the incident as required.
Deficiencies (1)
| Description |
|---|
| Failure to investigate and report to the state agency an incident involving a resident's fall resulting in a fractured hip and alleged staff abuse. |
Report Facts
Census: 27
Residents sampled for accidents: 3
Resident admission date: Jun 11, 2014
Admission MDS assessment date: Jun 18, 2014
Incident date: Sep 1, 2014
Investigation receipt date: Oct 21, 2014
Resident interview date: Oct 7, 2014
Inspection Report
Follow-Up
Deficiencies: 12
Oct 22, 2014
Visit Reason
This post-certification revisit was conducted to verify that previously identified deficiencies from the CMS-2567 Statement of Deficiencies and Plan of Correction were corrected.
Findings
All deficiencies previously cited were corrected as of 09/20/2014, with no uncorrected deficiencies noted at the time of this revisit.
Deficiencies (12)
| Description |
|---|
| Deficiency related to regulation 483.13(c) |
| Deficiency related to regulation 483.20(b)(1) |
| Deficiency related to regulation 483.20(g)-(j) |
| Deficiency related to regulation 483.25 |
| Deficiency related to regulation 483.25(c) |
| Deficiency related to regulation 483.25(h) |
| Deficiency related to regulation 483.25(i) |
| Deficiency related to regulation 483.25(l) |
| Deficiency related to regulation 483.30(b) |
| Deficiency related to regulation 483.60(c) |
| Deficiency related to regulation 483.65 |
| Deficiency related to regulation 483.75(n) |
Report Facts
Deficiencies corrected: 12
Inspection Report
Re-Inspection
Deficiencies: 3
Sep 20, 2014
Visit Reason
This is a revisit report to verify that previously reported deficiencies have been corrected and to document the dates such corrective actions were accomplished.
Findings
The report confirms that the deficiencies identified in regulations 26-41-202 (a), 26-41-202 (h), and 26-41-205 (d)(3) were corrected as of 09/20/2014.
Deficiencies (3)
| Description |
|---|
| Deficiency related to regulation 26-41-202 (a) |
| Deficiency related to regulation 26-41-202 (h) |
| Deficiency related to regulation 26-41-205 (d)(3) |
Inspection Report
Plan of Correction
Deficiencies: 13
Sep 20, 2014
Visit Reason
This document is a Plan of Correction submitted by Crestview Nursing in response to deficiencies cited during a prior survey.
Findings
The plan outlines corrective actions for multiple deficiencies including abuse policy updates, comprehensive assessments, MDS accuracy, neurological checks, pressure sore prevention, elopement safety, care plans for weight loss, pharmacy services, staffing patterns, infection control, and transfer agreements. Each corrective action includes monitoring and compliance measures with a target substantial compliance date of September 20, 2014.
Severity Breakdown
D: 8
F: 3
K: 1
: 1
Deficiencies (13)
| Description | Severity |
|---|---|
| Failure to maintain compliance with federal Medicare and Medicaid requirements | — |
| Abuse policy not reflecting current requirements and practices | D |
| Incomplete comprehensive assessments and care plans | D |
| Inaccurate Minimum Data Set (MDS) coding | D |
| Neurological check policy not assuring residents' highest practical wellbeing | D |
| Failure to prevent pressure sores and provide necessary treatment | D |
| Safety risks related to resident elopement | K |
| Inadequate comprehensive care plans for residents at risk for weight loss | D |
| Pharmacy services deficiencies including unnecessary drugs and policy gaps | D |
| Insufficient staffing patterns to ensure eight hours of consecutive RN coverage | F |
| Pharmacist's monthly review deficiencies | D |
| Failure to prevent spread of infection and inadequate infection control practices | F |
| Lack of transfer agreement with local hospital | F |
Report Facts
Date for substantial compliance: Sep 20, 2014
Number of residents per aide assignment: 8
Elopement monitoring frequency: 30
Elopement monitoring frequency: 15
Dates of recent elopement drills: Jul 24, 2014
Dates of recent elopement drills: Aug 25, 2014
Date of staff inservice on elopement: Aug 1, 2014
Date of door alarm policy inservice: Aug 18, 2014
Date of installation of coded touch pad lock: Jul 25, 2014
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shirley Boltz | Contact for Plan of Correction assistance | Listed as contact person for assistance with Plan of Correction |
| Sarasourk | Executive Director | Submitted the Plan of Correction |
| Irina Strakhova | Added and modified the Plan of Correction |
Inspection Report
Plan of Correction
Deficiencies: 3
Sep 8, 2014
Visit Reason
This document is a Plan of Correction submitted by Crestview Nursing ALF in response to deficiencies cited during a prior survey.
Findings
The plan addresses deficiencies related to NSA signing by legal POA and licensed nurses, and documentation of medication administration times, with corrective actions including policy updates, staff inservices, and monitoring by the Quality Assurance team.
Deficiencies (3)
| Description |
|---|
| Failure to ensure NSA signing by legal POA. |
| Failure to ensure NSA signing by licensed nurse for required health care services. |
| Deficiency in documentation of medication administration times. |
Report Facts
Complete Date for Plan of Correction: Sep 20, 2014
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shirley Boltz | Contact for Plan of Correction assistance | |
| Sarasourk | Operator | Submitted the Plan of Correction |
| Irina Strakhova | Added and modified the Plan of Correction |
Inspection Report
Complaint Investigation
Census: 29
Deficiencies: 12
Aug 21, 2014
Visit Reason
The inspection was conducted as a Health Resurvey and Complaint Investigation, including Extended Health Resurvey, to assess compliance with regulatory requirements.
Findings
The facility was found deficient in multiple areas including failure to maintain active CNA certification, incomplete comprehensive assessments, inaccurate Minimum Data Set (MDS) assessments, failure to complete neurological checks post-fall, inadequate pressure ulcer care, insufficient supervision to prevent resident elopement, failure to maintain RN coverage for 8 consecutive hours, failure to monitor effectiveness of behavioral medications, improper infection control practices, and lack of a hospital transfer agreement.
Complaint Details
The visit included a complaint investigation identified by complaint numbers #KS00077904 and #KS00077712, along with a Health Resurvey and Extended Health Resurvey.
Severity Breakdown
SS=D: 6
SS=K: 1
SS=E: 1
SS=F: 3
Deficiencies (12)
| Description | Severity |
|---|---|
| Failure to have documentation of an active certification for 1 direct care staff and failure to incorporate CMS letter on reporting reasonable suspicion of crime into policy. | SS=D |
| Failure to complete Care Area Assessments (CAAs) for 2 of 14 residents sampled. | SS=D |
| Failure to accurately complete Minimum Data Set (MDS) assessments for 2 residents. | SS=D |
| Failure to complete neurological checks for 1 resident with history of falls. | SS=D |
| Failure to follow plan of care for pressure ulcers for 1 resident. | SS=K |
| Failure to provide supervision to prevent elopement for 1 cognitively impaired resident and failure to maintain a safe environment free from tools. | SS=E |
| Failure to monitor supplement intake and document food preferences for 1 resident with weight loss. | SS=D |
| Failure to monitor effectiveness of behavioral medications for 1 resident. | SS=F |
| Failure to provide RN coverage for 8 consecutive hours on 6 days during June to August 2014. | SS=D |
| Pharmacy consultant failed to identify and report lack of monitoring for effectiveness of behavioral medications for 1 resident. | SS=F |
| Failure to handle laundry to prevent cross contamination and failure to cover drinking containers during transport. | SS=F |
| Failure to have a transfer agreement with a local hospital. | — |
Report Facts
Deficiency counts: 12
Resident sample size: 14
RN coverage days lacking 8 consecutive hours: 6
Weight loss percentage: 6.8
Distance resident eloped: 0.6
Behavioral medication monitoring months missing: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Administrative Staff | Mentioned in relation to CNA certification issue, abuse policy update, door alarm issues, and elopement incident. |
| Staff D | Administrative Licensed Nursing Staff | Acknowledged incomplete CAAs, inaccurate MDS, elopement incident, and behavioral medication monitoring. |
| Staff F | Administrative Nursing Staff | Provided statements on neurological checks, elopement incident, and medication monitoring. |
| Staff H | Licensed Nursing Staff | Involved in neurological checks, supplement monitoring, elopement incident, and behavioral medication monitoring. |
| Staff P | Direct Care Staff | Mentioned in supplement monitoring and elopement supervision. |
| Staff S | Direct Care Staff | Mentioned in pressure ulcer care. |
| Pharmacy Consultant KK | Pharmacy Consultant | Failed to identify and report lack of behavioral medication monitoring. |
Inspection Report
Renewal
Census: 8
Deficiencies: 3
Aug 21, 2014
Visit Reason
The inspection was a licensure resurvey of an Assisted Living/Residential Healthcare facility to assess compliance with regulatory requirements.
Findings
The facility failed to ensure the development of written Negotiated Service Agreements (NSA) in collaboration with residents' legal representatives and failed to include licensed nurse signatures on NSAs when health care services were required. Additionally, the facility did not document medication administration times on the medication administration records (MAR) for sampled residents.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to develop a written Negotiated Service Agreement (NSA) in collaboration with the resident's legal representative for one sampled resident. | SS=D |
| Failure to ensure the NSA was signed by a licensed nurse when health care services were required for three sampled residents. | SS=D |
| Failure to document medication administration times on the medication administration record (MAR) for three sampled residents. | SS=D |
Report Facts
Census: 8
Sampled residents: 3
Inspection Report
Renewal
Deficiencies: 2
Aug 21, 2014
Visit Reason
The inspection was a Health recertification survey conducted by the Kansas Department for Aging & Disability Services to determine if the facility was in compliance with Federal participation requirements for nursing homes participating in Medicare and/or Medicaid programs.
Findings
The survey found that the facility was not in substantial compliance with participation requirements and that conditions constituted immediate jeopardy to resident health or safety from July 27, 2014 through August 19, 2014. The facility was cited for substandard quality of care and faced enforcement remedies including denial of payment for new admissions and possible termination of provider agreement.
Severity Breakdown
Immediate Jeopardy: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Noncompliance with F323"K", CFR 01-483.25(h) constituting immediate jeopardy to resident health or safety | Immediate Jeopardy |
| Noncompliance related to F314, Pressure Ulcers | — |
Report Facts
Denial of payment effective date: Nov 21, 2014
Provider agreement termination date: Feb 21, 2015
Civil Money Penalty minimum amount: 5000
IDR submission timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sara Sourk | Administrator | Named as facility administrator in relation to survey and findings |
| Irina Strakhova | Enforcement Coordinator | Signed letter and contact for questions concerning instructions |
Inspection Report
Life Safety
Deficiencies: 1
Mar 12, 2014
Visit Reason
A Life Safety Code survey was conducted by the State Fire Marshal's Office to determine if the facility complied with Federal requirements for nursing homes participating in Medicare and/or Medicaid programs.
Findings
The survey found the most serious deficiencies to be 'F' level, widespread, with no harm but potential for more than minimal harm that is not immediate jeopardy. A plan of correction was required, and remedies including denial of payments and possible termination of provider agreement were recommended if substantial compliance was not achieved.
Severity Breakdown
F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Most serious deficiencies found to be 'F' level, widespread, with no harm but potential for more than minimal harm that is not immediate jeopardy. | F |
Report Facts
Denial of payments effective date: Jun 12, 2014
Provider agreement termination date: Sep 12, 2014
Plan of correction submission timeframe: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sara Sourk | Administrator | Facility administrator named in the report header |
| Brenda McNorton | Director of Fire Prevention Division | Contact for Informal Dispute Resolution process |
| Irina Strakhova | Enforcement Coordinator | Signed the report as Enforcement Coordinator |
Inspection Report
Follow-Up
Deficiencies: 1
Nov 18, 2013
Visit Reason
This visit was a post-certification revisit to verify that deficiencies previously reported on the CMS-2567 Statement of Deficiencies and Plan of Correction had been corrected.
Findings
The report confirms that the previously cited deficiency with regulation 483.25(h) was corrected by 09/30/2013. No other deficiencies or issues are noted.
Deficiencies (1)
| Description |
|---|
| Deficiency related to regulation 483.25(h) |
Report Facts
Deficiency correction date: Sep 30, 2013
Inspection Report
Plan of Correction
Deficiencies: 1
Sep 30, 2013
Visit Reason
This document is a Plan of Correction submitted in response to deficiencies identified during a complaint-related survey at Crestview Manor.
Findings
The facility identified concerns related to resident elopement risks and has developed a comprehensive plan to ensure compliance, including updated policies, staff training, environmental adjustments, and ongoing monitoring.
Complaint Details
The Plan of Correction is in response to a complaint survey (Event ID 22GL11) at Crestview Manor.
Deficiencies (1)
| Description |
|---|
| Failure to assure all residents are identified, monitored, and prevented from eloping. |
Report Facts
Resident to aide ratio: 8
Plan of correction completion date: Sep 30, 2013
Staff inservice date: Sep 24, 2013
Inspection Report
Complaint Investigation
Census: 32
Deficiencies: 1
Sep 25, 2013
Visit Reason
The inspection was conducted as a complaint investigation (#KS68105) due to concerns about supervision and accident hazards related to a cognitively impaired resident at risk for elopement.
Findings
The facility failed to provide adequate supervision to a cognitively impaired resident at risk for elopement, who left the facility unsupervised and traveled 1.7 miles crossing a 4-lane highway and railroad tracks, placing the resident in immediate jeopardy. The facility's policies and care plans were reviewed and corrective actions were implemented to prevent recurrence.
Complaint Details
Complaint investigation #KS68105. The resident was found to have eloped from the facility, was missing for approximately 50 minutes, and was located 1.7 miles away. The resident was cognitively impaired with dementia and Alzheimer's disease and required supervision to prevent elopement. The facility failed to provide adequate supervision and monitoring.
Severity Breakdown
D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to provide supervision for a cognitively impaired resident at risk for elopement, resulting in the resident leaving the facility unsupervised and traveling 1.7 miles crossing a highway and railroad tracks. | D |
Report Facts
Census: 32
Residents at risk for elopement: 8
Residents sampled for elopement risk: 3
Distance resident eloped: 1.7
Fall Risk Assessment score: 18
BIMS score: 7
BIMS score: 9
Temperature: 81.7
Temperature: 79
Humidity: 50
Wind speed: 4.6
Train speed: 10
Train speed: 30
Inspection Report
Follow-Up
Deficiencies: 2
Jul 1, 2013
Visit Reason
This post-certification revisit was conducted to verify correction of previously cited deficiencies from the CMS-2567 Statement of Deficiencies and Plan of Correction.
Findings
The revisit report shows that the deficiencies identified under regulations 483.25(d) and 483.25(h) were corrected as of 07/01/2013.
Deficiencies (2)
| Description |
|---|
| Deficiency under regulation 483.25(d) |
| Deficiency under regulation 483.25(h) |
Report Facts
Deficiencies corrected: 2
Inspection Report
Plan of Correction
Deficiencies: 2
Jun 10, 2013
Visit Reason
This document is a Plan of Correction submitted by the facility in response to deficiencies cited during a prior survey.
Findings
The facility has developed and will implement a system to assure continued compliance with regulations, including incontinent care procedures and comprehensive care plans to prevent injury and accidents. Staff education and monitoring processes are scheduled to ensure ongoing compliance.
Severity Breakdown
D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Incontinent care procedure deficiencies addressed with staff training and care plan updates. | D |
| Deficiency related to providing a safe, sanitary, and comfortable environment to prevent injury and accidents, with care plan updates and staff education scheduled. | D |
Report Facts
Complete Date for F0000: Jun 10, 2013
Complete Date for F315-D: Jul 1, 2013
Complete Date for F323-D: Jul 1, 2013
Inspection Report
Re-Inspection
Census: 29
Deficiencies: 2
Jun 3, 2013
Visit Reason
The inspection was a Health Resurvey to assess compliance with regulatory requirements related to resident care and safety.
Findings
The facility failed to provide appropriate incontinence care for a severely cognitively impaired resident requiring extensive assistance, and failed to consistently provide supervision and use of safety devices such as body and motion sensor alarms for a resident at high risk for falls.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to provide incontinence care according to the care plan for a resident with severe cognitive impairment requiring extensive assistance. | SS=D |
| Failed to ensure the resident environment was free of accident hazards and failed to provide adequate supervision and use of assistive devices to prevent accidents for a resident at high risk for falls. | SS=D |
Report Facts
Census: 29
Sample size: 18
Residents reviewed for falls: 3
Fall risk assessment score: 27
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Direct care staff O | Interviewed regarding incontinence care and body alarm placement. | |
| Direct care staff P | Interviewed regarding toileting prompts. | |
| Licensed nursing staff H | Interviewed regarding toileting prompts and fall risk interventions. | |
| Administrative nursing staff D | Interviewed regarding care plan expectations and fall risk interventions. | |
| Direct care staff Q | Interviewed and observed assisting resident transfers and fall risk. | |
| Direct care staff R | Observed assisting resident transfers. |
Inspection Report
Renewal
Deficiencies: 0
Jun 3, 2013
Visit Reason
The visit was a licensure resurvey of the facility to assess compliance with regulatory requirements.
Findings
The licensure resurvey resulted in a finding of no deficiency citations.
Inspection Report
Follow-Up
Deficiencies: 1
Dec 19, 2012
Visit Reason
This post-certification revisit was conducted to verify that deficiencies previously reported on the CMS-2567 Statement of Deficiencies and Plan of Correction have been corrected.
Findings
The report confirms that the previously cited deficiency with ID Prefix F0323 related to regulation 483.25(h) was corrected as of 12/01/2012.
Deficiencies (1)
| Description |
|---|
| Deficiency previously cited under regulation 483.25(h) with ID Prefix F0323 |
Report Facts
Deficiency correction date: Dec 1, 2012
Inspection Report
Plan of Correction
Deficiencies: 1
Nov 29, 2012
Visit Reason
This document is a Plan of Correction submitted in response to deficiencies cited during a complaint survey at the facility.
Findings
The facility identified deficiencies related to the use and safety of side rails and has implemented a facility-wide system to ensure compliance, including assessments, care plan updates, removal of side rails, and ongoing monitoring by the Quality Assurance committee.
Complaint Details
This Plan of Correction is in response to a complaint survey identified as Crestview 111912 Complaint Revised.
Deficiencies (1)
| Description |
|---|
| Deficiencies related to the use and safety of side rails, including risk of entrapment and compliance with FDA regulations. |
Report Facts
Compliance deadline: Dec 1, 2012
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shirley Boltz | Contact for Plan of Correction assistance | |
| Sara Sourk | Executive Director | Submitted the Plan of Correction |
| Irina Strakhova | Added the Plan of Correction | |
| Mary Jane Kennedy | Modified the Plan of Correction |
Inspection Report
Complaint Investigation
Census: 28
Deficiencies: 3
Nov 19, 2012
Visit Reason
Complaint Investigation and Partial Extended Survey #KS61514 conducted to assess safety hazards and supervision related to side rails and air flow mattresses for residents.
Findings
The facility failed to assess the safety of using alternating air mattresses with side rails for cognitively impaired, dependent residents, resulting in a resident found on the floor with neck pressed against side rails causing injury. The facility also failed to conduct side rail assessments and provide staff training on low air loss mattresses, placing residents at risk for falls and injury.
Complaint Details
The visit was complaint-related as indicated by the report title and findings addressing specific resident safety concerns following a fall incident on 11/1/12.
Severity Breakdown
Immediate Jeopardy: 1
D: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to assess safety of using alternating air mattress with side rails for a dependent, cognitively impaired resident, resulting in resident injury. | Immediate Jeopardy |
| Failure to conduct side rail assessments for residents using side rails. | Scope and Severity D |
| Failure to provide staff training on low air loss mattress use and precautions. | Scope and Severity D |
Report Facts
Census: 28
Residents with soft touch side rails: 5
Residents using air flow mattress: 4
Side rail opening measurements: 7.5
Pressure setting: 4
Alternate pressure cycle: 15
Resident #2 fall risk score: 24
Resident #3 fall risk score: 16
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Nurse C | Licensed Nurse | Interviewed regarding resident falls, side rail use, and mattress settings |
| Administrative Nursing Staff A | Administrative Nursing Staff | Interviewed regarding side rail assessments and facility policies |
| Administrative Nursing Staff B | Administrative Nursing Staff | Interviewed regarding mattress pressure settings and resident repositioning |
| Direct Care Staff E | Direct Care Staff | Interviewed regarding mattress settings and resident care |
| Direct Care Staff F | Direct Care Staff | Interviewed regarding resident positioning and care on 11/1/12 |
| Activity Staff D | Activity Staff | Observed resident fall and summoned nurse |
| Direct Care Staff G | Direct Care Staff | Observed resident transfer requiring extensive assistance |
| Direct Care Staff H | Direct Care Staff | Observed resident transfer requiring extensive assistance |
Inspection Report
Plan of Correction
Deficiencies: 2
N066003 POC DZGI11
Visit Reason
This document is a Plan of Correction submitted by Crestview Nursing in response to deficiencies cited during a survey conducted on October 24, 2024.
Findings
The plan addresses deficiencies related to PTSD care planning and infection control regarding the offering of the PCV20 vaccine to residents. The facility outlines corrective actions including staff education, audits, and ongoing monitoring to ensure compliance.
Severity Breakdown
D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Deficiency related to PTSD and identifying trauma in residents' plans of care. | D |
| Deficiency related to not preventing the spread of infection by assuring all residents were offered the PCV20 vaccine. | D |
Report Facts
Deficiency cited date: Oct 24, 2024
Plan of correction completion date: Nov 15, 2024
Audit date: Nov 4, 2024
Inspection Report
Plan of Correction
Deficiencies: 3
N066003 POC O91B11
Visit Reason
This document is a Plan of Correction submitted by Crestview Nursing and Rehabilitation in response to deficiencies cited during a prior survey.
Findings
The plan addresses deficiencies related to medication storage, food preparation and handling, and infection control practices. The facility outlines corrective actions including staff re-education, competency checks, monitoring by designated staff, and equipment improvements to ensure compliance.
Severity Breakdown
D: 1
E: 1
F: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Deficiency cited for proper medication storage, specifically dating insulin when opened. | D |
| Deficiency cited for food preparation and handling, including proper labeling and storage of food items and prevention of cross contamination. | F |
| Deficiency cited for infection control practices, including preventing spread of infection during snack pass and blood glucose monitoring. | E |
Report Facts
Complete Date for F0000: Plan of correction completion date 11/10/2021
Completion Date for F761-D: Plan of correction completion date 12/02/2021
Completion Date for F812-F: Plan of correction completion date 12/02/2021
Completion Date for F880-E: Plan of correction completion date 12/02/2021
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