22 Reports
Inspection Report — Apr 17, 2025
Annual Inspection CMS
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
Routine State
Date: Nov 21, 2024
Visit Reason
No deficiencies noted during this inspection.
Findings
No deficiencies noted during this inspection.
Inspection Report — Nov 21, 2024
State
Date: Nov 21, 2024
Visit Reason
State-compiled facility profile showing multiple inspections from 2012 to 2024 with deficiency history and inspection statuses.
Findings
Across the inspections, the facility had a mix of no deficiencies, deficiencies cited, and deficiencies corrected. Several complaint and standard inspections showed deficiencies cited and later corrected, indicating ongoing regulatory oversight.
Citations (3)
Deficiencies Cited
Deficiencies Corrected
No Deficiencies
Report Facts
Inspections on page: 24
Inspection Report — Nov 17, 2023
Complaint Investigation State
Date: Nov 17, 2023
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Aug 23, 2023
Complaint Investigation CMS
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 CMS
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 — Mar 22, 2023
Routine State
Date: Mar 22, 2023
Visit Reason
Multiple Class 3 deficiencies related to resident care, medication, staffing, training, and emergency management.
Findings
Multiple Class 3 deficiencies related to resident care, medication, staffing, training, and emergency management.
Citations (10)
Tag A0008 — ADMISSIONS - HEALTH ASSESSMENT
Tag A0025 — RESIDENT CARE - SUPERVISION
Tag A0030 — RESIDENT CARE - RIGHTS & FACILITY PROCEDURES
Tag A0052 — MEDICATION - ASSISTANCE WITH SELF-ADMIN
Tag A0056 — MEDICATION - LABELING AND ORDERS
Tag A0078 — STAFFING STANDARDS - STAFF
Tag A0081 — TRAINING - STAFF IN-SERVICE
Tag A0090 — TRAINING - DO NOT RESUSCITATE ORDERS
Tag A0165 — RISK MGMT & QA
Tag CZ830 — EMERGENCY MANAGEMENT PLANNING
Inspection Report — Aug 4, 2022
Complaint Investigation State
Date: Aug 4, 2022
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Feb 16, 2022
Complaint Investigation State
Date: Feb 16, 2022
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Sep 10, 2021
Routine CMS
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 |
Inspection Report — Oct 20, 2020
Routine State
Date: Oct 20, 2020
Visit Reason
Two Class 3 deficiencies related to medication records and staffing standards.
Findings
Two Class 3 deficiencies related to medication records and staffing standards.
Citations (2)
Tag A0054 — MEDICATION - RECORDS
Tag A0078 — STAFFING STANDARDS - STAFF
Inspection Report — Oct 7, 2019
Complaint Investigation State
Date: Oct 7, 2019
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Aug 7, 2018
Routine State
Date: Aug 7, 2018
Visit Reason
No deficiencies noted during this inspection.
Findings
No deficiencies noted during this inspection.
Inspection Report — Oct 26, 2017
Complaint Investigation State
Date: Oct 26, 2017
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Feb 2, 2017
Complaint Investigation State
Date: Feb 2, 2017
Visit Reason
Two Class 3 deficiencies related to resident care supervision and resident records.
Findings
Two Class 3 deficiencies related to resident care supervision and resident records.
Citations (2)
Tag A0025 — RESIDENT CARE - SUPERVISION
Tag A0162 — RECORDS - RESIDENT
Inspection Report — Aug 15, 2016
Routine State
Date: Aug 15, 2016
Visit Reason
No deficiencies noted during this inspection.
Findings
No deficiencies noted during this inspection.
Inspection Report — May 29, 2015
Complaint Investigation State
Date: May 29, 2015
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Mar 5, 2015
Complaint Investigation State
Date: Mar 5, 2015
Visit Reason
One Class 3 deficiency related to resident care supervision.
Findings
One Class 3 deficiency related to resident care supervision.
Citations (1)
Tag A0025 — RESIDENT CARE - SUPERVISION
Inspection Report — Jan 5, 2015
Complaint Investigation State
Date: Jan 5, 2015
Visit Reason
No deficiencies noted during this complaint investigation.
Findings
No deficiencies noted during this complaint investigation.
Inspection Report — Oct 9, 2014
State
Date: Oct 9, 2014
Visit Reason
Two Class 3 deficiencies related to medication assistance with self-administration and medication labeling and orders.
Findings
Two Class 3 deficiencies related to medication assistance with self-administration and medication labeling and orders.
Citations (2)
Tag A0052 — MEDICATION - ASSISTANCE WITH SELF-ADMIN
Tag A0056 — MEDICATION - LABELING AND ORDERS
Inspection Report — Aug 16, 2013
State
Date: Aug 16, 2013
Visit Reason
No deficiencies noted during this inspection.
Findings
No deficiencies noted during this inspection.
Inspection Report — Dec 17, 2012
Routine State
Date: Dec 17, 2012
Visit Reason
No deficiencies noted during this inspection.
Findings
No deficiencies noted during this inspection.
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