5 Reports
Inspection Report — Apr 17, 2025
Annual Inspection
Date: Apr 17, 2025
Visit Reason
Annual inspection survey conducted to assess compliance with health and safety regulations at Cypress Village nursing home.
Findings
No health deficiencies were found during the inspection.
Inspection Report — Nov 21, 2024
Date: Nov 21, 2024
Visit Reason
The page covers the entire inspection history of Inn at Cypress Village, the, including routine and complaint inspections.
Findings
Across 20 visits from December 17, 2012 to November 21, 2024, 5 visits cited deficiencies, totaling 17 Class 3 deficiencies with no serious deficiencies. One legal action with a $500 fine was recorded.
Citations (17)
Admissions - Health Assessment — cited March 22, 2023, corrected November 21, 2024
Resident Care - Supervision — cited March 22, 2023, corrected November 21, 2024
Resident Care - Rights & Facility Procedures — cited March 22, 2023, corrected November 21, 2024
Medication - Assistance With Self-admin — cited March 22, 2023, corrected November 21, 2024
Medication - Labeling and Orders — cited March 22, 2023, corrected November 21, 2024
Staffing Standards - Staff — cited March 22, 2023, corrected November 21, 2024
Training - Staff In-service — cited March 22, 2023, corrected November 21, 2024
Training - Do Not Resuscitate Orders — cited March 22, 2023, corrected November 21, 2024
Risk Mgmt & Qa — cited March 22, 2023, corrected November 21, 2024
Emergency Management Planning — cited March 22, 2023, corrected November 21, 2024
Medication - Records — cited October 20, 2020, corrected November 25, 2020
Staffing Standards - Staff — cited October 20, 2020, corrected November 25, 2020
Resident Care - Supervision — cited February 2, 2017, corrected February 10, 2017
Records - Resident — cited February 2, 2017, corrected April 27, 2017
Resident Care - Supervision — cited March 5, 2015, corrected June 3, 2015
Medication - Assistance With Self-admin — cited October 9, 2014, corrected October 21, 2014
Medication - Labeling and Orders — cited October 9, 2014, corrected October 21, 2014
Report Facts
Inspections: 20
Visits with deficiencies: 5
Clean visits: 10
Deficiencies: 17
Serious deficiencies: 0
Legal actions: 1
Total fines: 500
Inspection Report — Aug 23, 2023
Complaint Investigation
Date: Aug 23, 2023
Visit Reason
The inspection was conducted due to a complaint regarding the facility's failure to provide correct discharge paperwork to a resident, potentially hindering continuous and coordinated care.
Complaint Details
The complaint was substantiated. Resident #1 was discharged on 7/8/23 and given incorrect discharge paperwork. The resident's wife reported the issue on 7/10/23. The facility acknowledged the error and requested the incorrect paperwork be shredded. The correct paperwork was not confirmed as received, delaying outpatient therapy.
Findings
The facility failed to provide a discharge summary for one resident, giving them another person's discharge paperwork. This error delayed the resident's outpatient therapy and the facility could not confirm if the correct paperwork was eventually provided.
Citations (1)
F 0661: The facility failed to ensure necessary information was communicated to the resident and receiving health care provider at the time of a planned discharge. Resident #1 was given another person's discharge paperwork, potentially hindering continuous and coordinated care.
Report Facts
Residents reviewed for discharge: 7
Residents with discharge paperwork error: 1
Admission date: Jun 16, 2023
Discharge date: Jul 8, 2023
BIMS score: 15
Inspection Report — May 25, 2023
Follow-Up
Date: May 25, 2023
Visit Reason
Follow-up inspection to evaluate compliance with food safety and sanitation practices and to assess nutritional care related to enteral feeding for Resident #346.
Findings
The facility failed to maintain adequate nutritional care for Resident #346 by not obtaining weights as frequently as ordered and providing incorrect enteral feeding formula. Additionally, the kitchen food service failed to maintain proper cleaning and sanitation of food preparation equipment, posing a risk of foodborne illness to residents.
Citations (2)
F 0692: The facility failed to maintain acceptable nutritional status for Resident #346 by not obtaining weights as frequently as prescribed and providing enteral feeding formula inconsistent with physician orders.
F 0812: The facility failed to ensure food preparation equipment was clean and maintained, with grease and food debris buildup on ovens, fryers, and other kitchen equipment, risking foodborne illness.
Report Facts
Resident weights recorded: 3
Weight loss percentage: 4
Nurses administering feeding: 12
Feeding rate: 250
Flush volume: 150
Employees mentioned
| Name | Title | Context |
|---|---|---|
| A | Licensed Practical Nurse (LPN) | Interviewed regarding enteral nutrition and formula administration for Resident #346 |
| B | Licensed Practical Nurse (LPN) / Unit Manager | Interviewed about formula verification and resident weighing procedures |
| C | Agency Licensed Practical Nurse (LPN) | Interviewed about knowledge of enteral nutrition formula orders |
| D | Kitchen Coordinator / Cook | Interviewed about responsibility for cleaning kitchen equipment |
| F | Certified Dietary Manager (CDM) | Confirmed responsibility for ensuring kitchen equipment cleaning |
| Registered Dietitian (RD) | Registered Dietitian | Interviewed about nutritional needs and formula changes for Resident #346 |
| DON | Director of Nursing | Interviewed about formula orders and supply issues for Resident #346 |
Inspection Report — Sep 10, 2021
Routine
Date: Sep 10, 2021
Visit Reason
The inspection was conducted to assess compliance with professional standards of quality, nurse staffing posting requirements, equipment safety, and proper care and treatment of residents, including wound care and catheter management.
Findings
The facility failed to assess and document a resident's observed bleeding from a urinary catheter, failed to notify the physician timely, failed to post daily nurse staffing data accurately for multiple days, and failed to ensure the dish machine in the kitchen was properly sanitizing dishes due to lack of staff training and equipment maintenance.
Citations (4)
F 0658: The facility failed to assess Resident #130 when blood was observed oozing from the urethra around the urinary catheter and failed to notify the physician or document the change in condition, causing potential delay in treatment.
F 0684: The facility failed to provide appropriate treatment and care by not assessing or notifying the physician about Resident #130's bleeding from the urinary catheter, lacking documentation of the change in condition.
F 0732: The facility failed to post daily nurse staffing data accurately for 3 of 4 days observed, posting outdated census and staffing information.
F 0908: The facility failed to ensure the kitchen dish machine sanitized dishes properly due to detached sanitizer tubing, lack of staff training on sanitizer testing, and inaccurate documentation of sanitizer levels.
Report Facts
Sampled residents: 28
Days nurse staffing data not updated: 3
Dish machine sanitizer level: 0
Dish machine sanitizer level: 100
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Employee L | Staffing Coordinator | Interviewed about nurse staffing data posting practices |
| Registered Nurse (RN)/Wound Care Nurse E | Wound Care Nurse | Observed wound care and noted bleeding but failed to notify physician or document |
| Certified Nursing Assistant (CNA) F | Certified Nursing Assistant | Assisted with wound care for Resident #130 |
| Assistant Director of Nursing (ADON) | Assistant Director of Nursing | Interviewed regarding lack of documentation and follow-up on Resident #130's bleeding |
| RN Unit Manager (UM) H | RN Unit Manager | Interviewed about lack of nursing notes related to Resident #130's bleeding |
| Dietary Employee A | Dish Machine Operator | Observed operating dish machine, lacked training on sanitizer testing |
| Employee C | Dietary Director (DD) | Tested dish machine sanitizer levels and provided training |
| Registered Dietician (RD) | Registered Dietician | Interviewed about dish machine operation and sanitizer testing |
| Certified Dietary Manager (CDM) | Certified Dietary Manager | Observed dish machine sanitizer testing and corrected documentation errors |
4 CMS Surveys
CMS Survey — Aug 23, 2023
Aug 23, 2023
CMS Survey — Sep 10, 2021
Sep 10, 2021
CMS Survey — May 25, 2023
May 25, 2023
CMS Survey — Apr 17, 2025
Apr 17, 2025
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