Cypress Woods Care Center

Scope/severity K — IMMEDIATE JEOPARDY

Survey 2024-06-07 · Tag F0689 · Complaint investigation · Deficient, Provider has date of correction · Correction reported 2024-06-08

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

What this scope/severity letter means: CMS found a pattern of failures that caused, or were likely to cause, serious injury, harm, impairment, or death. This is the most serious finding a surveyor can make. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2026-01-13 · Tag F0880 · Complaint investigation · Deficient, Provider has date of correction · Correction reported 2026-01-15

Provide and implement an infection prevention and control program.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2025-01-08 · Tag F0770 · Routine survey · Deficient, Provider has date of correction · Correction reported 2025-01-24

Provide timely, quality laboratory services/tests to meet the needs of residents.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2024-05-09 · Tag F0656 · Complaint investigation · Deficient, Provider has date of correction · Correction reported 2024-05-16

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2023-11-30 · Tag F0641 · Complaint investigation · Deficient, Provider has date of correction · Correction reported 2023-12-20

Ensure each resident receives an accurate assessment.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2023-11-30 · Tag F0656 · Routine survey · Deficient, Provider has date of correction · Correction reported 2023-12-18

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity F — Potential for harm

Survey 2023-11-30 · Tag F0812 · Routine survey · Deficient, Provider has date of correction · Correction reported 2023-12-12

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it affected the facility broadly. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2022-09-23 · Tag F0641 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Ensure each resident receives an accurate assessment.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2022-09-23 · Tag F0655 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2022-09-23 · Tag F0656 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2022-09-23 · Tag F0657 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0690 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0695 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Provide safe and appropriate respiratory care for a resident when needed.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0700 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity E — Potential for harm

Survey 2022-09-23 · Tag F0804 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it happened repeatedly. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0808 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity F — Potential for harm

Survey 2022-09-23 · Tag F0812 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm, and it affected the facility broadly. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0842 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0880 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-11-04

Provide and implement an infection prevention and control program.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works

Scope/severity D — Potential for harm

Survey 2022-09-23 · Tag F0909 · Routine survey · Deficient, Provider has date of correction · Correction reported 2022-09-30

Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.

What this scope/severity letter means: No resident was harmed, but the failure could have caused more than minimal harm. Affected one resident or one instance. How the A–L grid works