Argentine Care Center

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain best practices in the food service area, with observations showing food-contact and nonfood-contact surfaces that were not clean, improper sanitizer concentration, and food held at unsafe temperatures. During the kitchen tour, the wiping cloth sanitizer bucket tested at zero on quat strips even though the Certified Dietary Manager stated it should be at least 200 and changed every 8 hours or as needed. The ice machine in the clean storage room had yellow-brown residue on the interior walls, and two coolers stored nearby had water pooling inside, water droplets on the walls, and black splotches on one cooler lid. An unlabeled spray bottle with yellowish liquid was also observed on the windowsill above the food prep area, and neither the CDM nor the employee knew what the liquid was. Food temperature control was also not maintained. During lunch observation, cottage cheese on a prep table was 47 degrees F, pizza on a plate behind the steam table was 102 degrees F, grilled cheese was 83 degrees F, and a tub of hamburger buns with cheese on the prep table was 54 degrees F. Staff stated the pizza would be microwaved later to warm it up, and the CDM stated hot food should be held at 135 degrees F or above and cold food below 41 degrees F. The CDM also stated the facility did not have a policy on hot and cold holding. A fly was observed above the tray line, and an employee touched a trash can lid after washing hands and then gloved hands before prepping food. Resident interviews supported concerns about food service quality and temperature. One resident, admitted with diagnoses including sepsis, diabetes, GERD, and chronic duodenal ulcer, reported that food often arrived cold, including scrambled eggs, French toast, bacon, and oatmeal, and said half the time it was cold. Another resident with diagnoses including debility, heart failure, depression, and COPD reported that the food temperature was usually off and that dinner was always cold whether eaten in the dining room or in the room. The report also noted that timely distribution is essential to ensure food and beverages are served at the proper temperature.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to practice best infection control methods in the soiled utility areas. On 03/24/2026, a hopper was observed in the first-floor soiled utility room with gloves and a face shield present, but no gowns available. Housekeeping Manager J stated the hopper was used to rinse bedpans and soiled linen. A second hopper was observed in the second-floor soiled utility room with gloves stored there, but no gowns or face shields were present. During the housekeeping tour, Housekeeping Manager J also stated there were several bathtubs in the facility that were not being used and that the tubs caused an odor, but they were flushed once a month. Maintenance Director K later stated the unused tubs were not being flushed. Unused tubs were observed on the second floor in both bathrooms adjacent to the stairs and in the bathroom in room [ROOM NUMBER], and the tub in room [ROOM NUMBER] did not turn on. The facility also failed to have an active plan for reducing the risk of legionella and other opportunistic pathogens of premise plumbing. On 03/25/2026, review of the water management plan showed it was missing a description of the water system using flow and text diagrams, where Legionella and other opportunistic waterborne pathogens can grow, and adequate control measures to prevent the growth and spread of Legionella. The legionella folder contained multiple test results from 2023, but there were no recent preventative measures taken in the past year. A legionella environmental assessment form was dated 2019 and had not been reassessed. When the DON and Maintenance Director K were asked whether the facility had a water system flow or text diagram, a list of high-risk areas for Legionella growth, or other missing water management plan information, they stated no and were unaware of the missing elements.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to mitigate the presence of pests, maintain safe hot water temperatures, and ensure appropriate backflow prevention at plumbing fixtures. During observation, an outside spigot and a basement spigot were both seen with attached hoses and spray nozzles downstream of hose bib vacuum breakers. The report also noted that atmospheric vacuum breakers shall not be installed where they will be under continuous pressure for more than 12 hours because there is no downstream shutoff valve. Environmental observations found used paper towels and a cloth towel on the floor behind the whirlpool in the first-floor shower room, along with several gnats flying around the room. The Housekeeping Manager stated the floors are cleaned every night and said the source of the gnats was unknown. In the same shower room, multiple used razors were overflowing on top of a sharps container dated 2/25/26, and the Housekeeping Manager stated the container should be changed every 30 days or when full. Record review and interview also showed hot water temperatures above the stated range, including readings of 153, 156, and 157 degrees at the restorative hand sink, while the Maintenance Director stated the boiler was set to 160 degrees and hot water was 140 degrees going out to the floor. In Resident 41's room, a kidney basin on the overbed table contained candy partially covered with a soiled washcloth, and fruit flies/gnats were observed flying around and landing on the dish, wall, and privacy curtain.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that a resident with intact cognition was treated with dignity during incontinence care. The resident had diagnoses including a left below-the-knee amputation, diabetes mellitus type 2, and polyneuropathy, and the MDS indicated he was occasionally incontinent. He reported that he was mostly incontinent at night, used briefs and a mattress pad, and requested assistance when both were soiled. He said staff told him they could not keep changing the pads because they would run out, placed a brief on him that was very uncomfortable and felt like a thong, and told him they had run out of larger briefs. He stated this made him feel embarrassed. The record and staff interviews showed that incontinence supplies were available in the facility. A CNA stated that if items ran out on the floor, they were usually available in the basement supply room, and another CNA escorted staff to the basement closet where there was ample supply of briefs in sizes from XS to 5XL. That CNA stated some staff were lazy and did not go to the basement or restock the supply closet, but overflow linens and supplies were available. Laundry staff also stated there was an overflow cart of clean linens in the basement and that floor carts were restocked regularly. The DON stated she had not had complaints about low supply of linens or briefs. The facility also failed to administer medications in accordance with resident preferences and timely medication administration practices for two residents. One resident and a family member for another resident reported that night shift medications were often late, including when the resident requested them on time. MAR review showed repeated 8 PM medications charted more than 1 to 3 hours late over multiple days in January, February, and March for both residents. A nurse stated medications should be given after verification, documented after administration, and if late, the reason should be entered in the record. The facility policy stated medications should be administered within 60 minutes before or after the scheduled time unless otherwise ordered.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to document an assessment and monitor open areas on a resident’s foot and failed to keep medical records accessible in the electronic medical record. Resident 41 was admitted with diagnoses including heart failure, obesity, cellulitis of the lower limb, anxiety, and chronic obstructive pulmonary disease. The resident also had a care plan history of picking at skin, recurring cellulitis, and fungal dermatitis/ulcers to both feet and ankles. During an interview and observation, the resident was found in bed with multiple blackened, scabbed areas on the toes, with swollen feet and ankles, and reported the areas were turning black and she did not know why. A review of the medical record showed no documentation of the wounds on the toes and no orders for treatment to the foot wounds. Weekly head-to-toe skin checks were not readily available in the electronic medical record, and staff reported that paper documents had to be scanned and uploaded. The DON stated there were no recent skin assessments uploaded in the EMR and that the facility was in the process of setting up wound documentation in the EMR, but it had not been started. Staff also reported that documents might still be in piles of paper or awaiting scanning, and one weekly skin check dated 3/6/26 was located during the review. Paper documentation that was found included weekly skin checks dated 2/24, 3/3, 3/6, 3/13, and 3/17. The 3/13/26 skin check noted an open area on the coccyx/between thighs and right foot, with the left foot circled on the diagram, but there was no clear assessment or treatment documentation for the open area on the foot. The DON reported the resident’s toes were being kept open to air and that there was no treatment for the toes. The NP paper note from the resident’s 3/24/26 visit documented a history of picking at scabs and toes when bored and causing bleeding, but the assessment and plan did not document further assessment of the foot wounds or a treatment plan. The facility policy required wound assessment data to be recorded in the medical record and paper documentation to be scanned and uploaded in a timely manner.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to store nebulizer equipment in a sanitary manner for Resident 41, one of two residents reviewed for respiratory care. During observation, the resident’s nebulizer was seen stored in a clear plastic bag hanging on the bedside table, assembled, and with moisture droplets visible in the medication chamber. The resident stated the last breathing treatment had been the day before and said the nebulizer was not used very often. A later observation with the DON present again found the nebulizer apparatus assembled and moisture visible inside the medication chamber. The DON stated the nebulizer should be rinsed after use and allowed to air dry before being stored in the bag. The facility policy titled Nebulizer Therapy stated the equipment should be cleaned after each use, disassembled after every treatment, rinsed with sterile or distilled water, shaken off, air dried on an absorbent towel, and stored only once completely dry.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide adequate supervision during a group activity involving five residents in the dayroom after dinner, resulting in a physical altercation between two residents. The incident began with an argument and escalated when beverages were thrown, followed by one resident punching another, who then retaliated. The altercation was not witnessed by staff but was captured on video, which was reviewed by the Administrator the following day. At the time of the incident, no staff were present in the dayroom, and the activity was unsupervised. As a result of the altercation, one resident sustained bruising and a laceration on the bridge of her nose, while the other complained of pain in her eye and jaw and had a scratch on her arm. Both residents were transferred to the hospital for evaluation and treatment. The facility's investigation substantiated that a resident-to-resident physical altercation had occurred. The records indicated that the group activity included residents with varying levels of cognition and behavioral issues, yet no supervision was provided during this time. Interviews with staff and the Social Services Director confirmed that there were no activities staff present after dinner, and residents who remained in the dayroom for independent activities were left unsupervised. Staff were occupied with other duties, such as passing medications and assisting residents to bed. The facility did not have an Activities Director at the time, and there was no plan in place to supervise residents during evening hours, despite the presence of residents with dementia and behavioral concerns.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to follow physician's orders and standards of practice regarding the administration of methadone to a resident with multiple diagnoses, including chronic pain, heart disease, and mental health conditions. After a recent fall, the resident's methadone dosage was reduced by physician order, but two nurses continued to administer the previous, higher dosage on multiple occasions. Documentation showed that the incorrect dosage was given on at least five separate dates, and there was uncertainty about whether a double dose was administered on one of those days. The medication administration records and narcotic logs confirmed these errors. The Director of Nursing (DON) was only aware of some of the medication errors and did not initiate an incident investigation until several days after the errors were reported, coinciding with the surveyor's presence at the facility. The DON was unaware of the full extent of the errors until the surveyor's review of the narcotic log. Additionally, not all staff involved in the errors received in-service education or counseling regarding medication administration errors, and one nurse denied making any mistakes despite documentation to the contrary. Further review revealed that medication errors were not documented in the resident's progress notes, and there was no evidence that the physician was notified of the errors. The facility's medication error policy provided to the surveyor was incomplete and did not emphasize the importance of physician notification. The medication administration policy required medications to be given as prescribed and errors to be documented and reviewed, but these procedures were not followed in this case.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

During a lunch meal observation, three residents did not receive their meal trays in a timely manner, despite the facility's posted lunch times of 11:30 to 11:45 AM. The dining area had 12 residents waiting, but the meal cart did not arrive from the kitchen until 12:00 PM. While most residents received their trays and began eating, three residents were left without meals. One resident became restless and vocalized frustration about repeated late meal deliveries, another resident wandered the dining room in her wheelchair and had to be redirected by staff, and the third resident remained quiet but appeared bored. The trays for these three residents were delivered significantly late, with the last tray arriving at 12:31 PM, well after the scheduled meal time. The DON confirmed the late delivery of the trays and explained that a misunderstanding in the kitchen led to one tray being sent to a resident's room instead of the dining area. The facility's Meal Distribution Policy requires timely and accurate delivery of meals, with nursing staff responsible for verifying meal accuracy and timeliness. The failure to deliver meals on time resulted in residents experiencing delays, distress, and dissatisfaction during the lunch period.

Plan Of Correction

The facility ensures that resident rights are met, including but not limited to providing timely meals. Residents #5, #37, and #47 receive their meals in a timely manner. Meal service for all three meals was audited on 3/17/25 by the Dietary Manager to monitor timeliness and identify any concerns. Nursing and Dietary Staff were re-educated prior to 4/7/25 by the DON and Dietary Manager, regarding survey results including but not limited to the residents' right to timely meal service, meal service policy, and mealtime guidelines. Management staff complete both formal and informal rounds and report any concerns. The Dietary Manager or designee will conduct weekly audits to review the timeliness of meals. These audits will be completed weekly for 4 weeks, then monthly. Any identified areas of concern will be immediately corrected. Results of the audits will be taken to the QAPI Committee for review and recommendation, and for the determination of continued monitoring. The Dietary Manager will be responsible for monitoring sustained compliance.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to adequately assess, monitor, and intervene for the nutritional and hydration needs of two residents. One resident, an 82-year-old with severe cognitive impairment and multiple diagnoses including Alzheimer's Disease and failure to thrive, experienced significant weight loss over a six-month period. Despite a dietitian's recommendation to increase nutritional supplements to four times daily, the facility did not implement this intervention, and records showed inconsistent or missing documentation of supplement administration and food intake. The care plan for this resident was not updated or revised in response to ongoing weight loss, and there was no consistent monitoring of food and supplement intake as required by physician orders and care plan approaches. Another resident, admitted with dementia and other medical conditions, did not have an admission weight recorded, nor was there a baseline or monthly weight documented as required by facility policy. This resident also lacked any documentation of food or fluid intake, and there was no nutrition or weight-related problem addressed in the care plan. During a dining observation, this resident's meal was delivered late, and the DON confirmed that the initial weight assessment was missed. The facility's policy requires admission weights within 24 hours and monthly weights, but these procedures were not followed for this resident. The deficiencies were identified through record review, staff interviews, and direct observation. The DON acknowledged the lack of consistent documentation and monitoring for both residents, including missed weights, unrecorded supplement administration, and incomplete food acceptance records. The facility's failure to follow its own policies and physician or dietitian recommendations contributed to the ongoing nutritional risks for the affected residents.

Plan Of Correction

The facility identifies, assesses, and monitors resident weights and ensures interventions to promote nutrition and prevent weight loss are in place. 1. Resident #19's nutritional status was assessed by the Dietitian on 2/27/25 and again by 4/7/25. His care plan was reviewed and revised, with interventions including acceptance/documentation of supplements reviewed with staff involved with his care. His MD was notified on 3/25/25 of his weight fluctuation. Resident #37 was weighed on 2/28/25; the Dietitian evaluated on 1/13/25 and will evaluate again before 4/7/25. She will be monitored for any weight concerns. 2. All residents are potentially affected. An audit of each resident's weight was reviewed by the Dietitian and Director of Nursing on 3/11/25 to determine any need for increased monitoring/interventions. Residents currently receiving supplements were reviewed for acceptance/tolerance of supplements and documentation of supplement intake. 3. The documentation of meal intake for high-risk residents was reviewed, and a new form was initiated on 3/17/25 after review/in-service by the DON with the nursing staff. Process was reviewed during in-service on 3/26/25. Processing and communication of dietician recommendations were reviewed and discussed with the DON, Dietary Manager, and Dietitian on 3/11/25 to ensure prompt follow-up. A weekly Nutrition At Risk (NAR) meeting will begin on 3/21/25 to review residents, including but not limited to new admissions, with the IDT and Dietary Manager. The DON will lead the meeting. Nursing staff were in-serviced on recording and reporting supplement percentages as well as residents' acceptance of supplements on 3/26/25 by the DON. Admission weight and weekly weights for four weeks were added to the admission standing batch orders on 3/21/25 to ensure communication, completion, and documentation. 4. The DON or designee will conduct weekly audits of Performance Monitoring related to weights, meal intake, and supplement documentation to ensure they are recorded and complete to monitor weight fluctuations. The audit will be completed weekly for four weeks, then monthly. Any identified areas of concern will be addressed and immediately corrected. Results of the audits will be taken to the QAPI Committee for review and recommendation, and for determination of continued monitoring. The DON will be responsible for monitoring sustained compliance.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when a resident with a history of diabetes, stroke, and transient ischemic attack was not provided with two prescribed diabetic medications, Jardiance and sitagliptin (Januvia), in a timely manner following admission. The resident was admitted with physician orders for both medications to be administered daily at 8:00 AM. However, documentation in the medication administration record showed that Jardiance was not administered at all from the time of admission through several days, and sitagliptin was also not administered on two days due to the medications being unavailable. Progress notes indicated that the pharmacy was contacted regarding the missing medications, and it was noted that the medications would be sent, but delays persisted. During this period, the resident experienced elevated blood sugar levels, with seven out of ten readings above 200 mg/dL. The resident expressed concern about their blood sugar control and was unsure about the names of all their diabetic medications due to memory issues following a stroke. Staff interviews revealed that the pharmacy had not supplied Jardiance and that there was uncertainty about the reason, possibly related to authorization requirements. An inspection of the medication cart confirmed the absence of pharmacy-supplied Jardiance and the presence of home-brought sitagliptin, which was not initially available for administration. The facility's pharmacy agreement required the pharmacy to notify the facility if a medication was unavailable, but there was no documentation of such notification for Jardiance. The lack of timely provision and administration of these essential diabetic medications constituted a failure to meet the pharmaceutical service requirements for the resident.

Plan Of Correction

The facility provides diabetic medications as ordered by the physician for residents. 1. Resident #151 no longer resides at the facility. 2. Each diabetic resident's orders/MAR were audited on 3/19/25 by the ADON to ensure all ordered medications are available and are administered per MD orders. 3. A policy for Unavailable Medications was developed on 3/20/25 and approved by the QAA team on 3/25/25. The DON or designee reviewed the policy guideline with the licensed nursing staff by 4/7/25. 4. The DON or designee will conduct weekly audits of Performance Monitoring related to the availability of medications, including but not limited to diabetic medications, weekly x 4, then monthly. Any identified areas of concern will be addressed and immediately corrected. Results of the audits will be taken to the QAPI Committee for review and recommendation and for determination of continued monitoring. The DON will be responsible for monitoring sustained compliance.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure proper storage and reconciliation of controlled substances, specifically Ativan vials, in the medication room backup supply. During an observation, it was found that the refrigerator containing the Ativan vials was unlocked, and the locked plastic box inside was not permanently affixed to the refrigerator. The number of Ativan vials inside the box was unclear, as they were stored in blue plastic bags and not visible. Nursing staff were unable to immediately access the key to the box, and there was confusion regarding the reconciliation process for these vials. The narcotic reconciliation booklet did not contain any documentation for the Ativan vials stored in the medication room refrigerator. Interviews with nursing staff and the DON revealed inconsistent practices and a lack of clear documentation regarding the reconciliation of the Ativan vials. The pharmacy consultant was reported to reconcile backup medications every other week, but the facility was unable to provide documentation to confirm that the Ativan vials had been reconciled. Additionally, the facility's policy required controlled substances to be monitored and reconciled to identify loss or diversion, but no evidence was provided to show that this was being done for the Ativan vials in question.

Plan Of Correction

The facility provides safe narcotic storage and reconciliation. 1. The emergency back-up Ativan was added to the downstairs medication cart narcotic perpetual inventory to reconcile every shift with narcotic counts; the secure box was secured to the refrigerator to prevent removal of the box. Pharmacy verified on 3/11/25 that the backup Ativan stock was correct. 2. Each medication cart was audited by the DON on 3/17/25 to ensure narcotic storage and reconciliation was complete. 3. Licensed nursing staff were re-educated on 3/26/25 by the DON or designee, regarding survey results including but not limited to the safe storage and reconciliation of refrigerated controlled medications. 4. The DON or designee will conduct weekly audits of Performance Monitoring related to safe narcotic storage and reconciliation weekly x 4, then monthly. Any identified areas of concern will be addressed and immediately corrected. Results of the audits will be taken to the QAPI Committee for review and recommendation and for determination of continued monitoring.