Above & Beyond at the Knights.

“Food was not stored in closed or sealed containers. A plastic bag of frozen breadsticks in the walk-in kitchen freezer was opened and unsealed.”

“The exit gate in the Secured Dementia Care Unit courtyard would only open approximately 6 inches, blocked by frozen ground, preventing immediate egress in an emergency.”

“Resident #1's Medication Administration Record was initialed to indicate Metoprolol was administered on 1-22-25, 1-19-25, and 1-16-25 at bedtime, but the medication was actually withheld per parameters. The MAR did not document that the medication was held.”

“Resident #2's most recent Resident Assessment and Support Plan assessment was completed on 2-26-24, but the prior assessment was completed on 1-16-23, missing the annual assessment deadline.”

“Resident #1 and Resident #3 were admitted to the SDCU, but their Documentation of Medical Evaluations (DME) were not completed within the required 60-day timeframe prior to admission.”

“Resident #3 was admitted to the SDCU but the resident's support plan (RASP) was not completed within 72 hours of admission.”

“A resident alleged that staff person A grabbed their shoulder and attempted to force them into the shower, causing shoulder pain. The home failed to submit a required plan of supervision to the Department within the mandated timeframe, despite placing the staff person under supervision and removing them from care for that resident.”

“A resident alleged that staff person A grabbed their shoulder and attempted to force them into the shower, causing shoulder pain. The home failed to submit an incident report to the Department regarding the allegation of abuse within the required 24-hour timeframe.”

“Empty pill packets containing residents' private information including names and medications were left on top of an unattended medication cart during initial walkthrough of memory care unit.”

“Resident home contracts for two residents were not signed by the residents as required.”

“Two residents did not have signed statements acknowledging receipt of residents' rights information as required.”

“The trash can located in the secured memory care unit kitchen did not have a cover to prevent penetration of insects and rodents.”

“Residents in two rooms did not have an operable lamp or other source of lighting that could be turned on at bedside.”

“The exit located in the dining room would not open without an excessive amount of force used, preventing immediate egress in the event of an emergency.”

“The memory care unit dining area did not have posted in a public and conspicuous location the home's menu for the current week and upcoming week's menu.”

“A resident was admitted to the home but the preadmission screening form was not completed within the required 30 days prior to admission.”