I think most of us would answer yes to this question!
I wanted to share a cool program that Adina Gray, SLP/DOR, and her team at Lake Village have started to meet the needs of their residents and see great improvements in this area:
At Lake Village in Lewisville, Texas, the therapy department saw a need for residents who either: didn’t enjoy showers, refused showers, had a decline in personal hygiene, and/or could benefit from some modifications and adaptations to their daily wash routine.
The OTs started by identifying the residents, and then we went about finding inexpensive but functional shower caddies (the Target College Essentials ones were perfect). They then talked to the residents and their families, and obtained the items that the patients would utilize and enjoy specific to them. For example, some families brought nice-smelling body wash, specific hair products for different hair textures,, good shavers and shaving cream for the men, etc. Items were labeled as necessary to help with carryover and ease of use.
We also established grooming and hygiene routines with laminated visual schedules for those who could follow them for doing things such as daily teeth brushing, washing their face and combing hair. And when OTs have established the routines and a patient is demonstrating good independence with the program, we then refer to ST in order to continue with carryover and use of visual aids and daily schedule to complete tasks as independently as possible.
Feel free to reach out to Adina (adhill@ensignservices.net) or your therapy resource with any questions!
Submitted by Barbara Mohrle, OTR, Therapy Resource, Keystone North
Submitted by Stephanie Argyle, COTA and Kyle Fairchild, OTR, ADOR
Whether a patient comes to St. Joseph Villa for a rehab stay due to a fall, a recent injury, a surgical procedure or other medical conditions, we aim to include each individual in our discharge planning group as they approach discharge. Our goal is to educate our patients in ways to improve safety, improve energy conservation and improve self-awareness as they prepare to return home. Each group member is given a packet of written information, which includes a home safety checklist, pictures of adaptive equipment and links for ordering, and home exercises. We change our handouts based on the needs of our patients at the time.
Our DC Planning Group objectives are as follows:
To identify barriers to discharge with a focus on current functional barriers
Education in home safety, home modifications, DME needed for safety in the home
Education in community resources for home safety
Education in self-awareness and techniques to facilitate relaxation and awareness of your body at rest
Education in the purpose of home health services and benefits of continuing therapy at home and as an outpatient
So many of our patients have expressed gratitude and appreciation as they learn from one of our OTs or COTAs AND from one another about adaptive equipment, techniques and strategies to improve their lives. One patient commented after attending the group, “I was so worried about falling in my bathroom. What you’ve taught me will make things much safer and easier — it will change my life!” We have allowed family members to attend our group, which has helped them learn how to better care for and support their loved ones. Overall, this education group has been a valuable addition and rewarding experience for both our patients and therapists!
By Ryan Hough, Therapy Resource – Gateway NE Kim cooper, our lead OT at Wayne Countryview Care and Rehab in Wayne NE, is a very clinically driven therapist who is always creatively implementing programming to address the needs of the residents. Kim recently identified several patients with low vision, and immediately went to work to strategize ways to improve their lives. She pursued a partnership with The Nebraska Commission for the Blind and Visually Impaired, and with their help and generous donations, they now have products for these residents to enhance their ability to participate and do day-to-day tasks. Some examples of the products donated are large bingo cards, large playing cards, writing templates, glare reducing sunglasses, dice with raised numbers, and an Eschenbach magnifier that works like a smart phone that you can move with fingers. When implementing any of these strategic interventions, remember to work with nursing to care plan the findings and the interventions provided.
Case Scenarios
Kim has a resident with severe macular degeneration. She has been staying in her room for meals because she was constantly spilling at meal time. Kim initiated therapy and worked closely with Nebraska Commission for the Blind. Kim designed a placement (picture attached) that lays out where the meal is all located so that she can find all of her utensils, foods and liquids. The placement is laminated and fits into the tray based on her vision loss. Patient was educated on the design of the placement along with the caregivers so that the lay out is always the same. This has resulted increased independence and self-esteem, as she now doesn’t need to stay in her room to eat meals. In part because of this success, they are exploring a discharge to an ALF that otherwise may not be possible.
Resident number 2 has severe glaucoma. This resulted in not being able to read the lunch menu, read the clock, read the activities schedule, and she stopped playing bingo because she couldn’t see the cards. They worked with Commission for Blind to get a talking clock, a magnifier similar to IPad size/Eschenbach magnifier that gives her color contrast, up to 12x the magnification, and camera to take a picture. Resident is much more engaged in daily activities within the facility and even resumed doing her cross-word puzzles.
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Submitted by Loupel Antiquiera, DOR, and Laura Kramer, COTA/L, Pacific Care Center, Hoquiam, WA
Laura Kramer, OT, provided the following exercise to promote OT month.
Residents are provided with a yoga ball placed on a base (like a round laundry basket) and a pair of drumsticks with instructions to follow the leader in a set of coordinated movements with lively music that has a strong musical beat. The variations of instructions may be tailored to the residents’ limitations and therapeutic goals. It can be upgraded or downgraded to tolerance throughout the task, with the therapist monitoring signs of fatigue or pain, cueing residents to rest if needed.
As the therapist, I may begin by explaining the benefits of the activity, which can include increased circulation, cardio exercise, targeted joint range of motion, music appreciation and most of all fun, but I always preface with “If it hurts, don’t do it.” Coordinated movements may include:
Elbow flexion only while drumming on the ball; downgrade to just wrist flexion if necessary to tap out the rhythm of the music
Knee up both right, then left
Reaching far right/far left, targeting shoulder abduction and trunk stability
Hands up with crossing drumsticks
Drumming to the beat, either slow or medium or double speed
One-handed (one-sided)
Overall, the benefits I’ve observed are promising, with most patients demonstrating very good attention and following directions, and some will even become happy to lead a set of instructions and take turns to try out their own combination. Some find the activity too simple and ask to leave, and one resident commented she thought it “felt like kindergarten, but it was still fun I guess.” However, this same resident actively participated again and was observed having fun. One resident required closer observation d/t asthma; her O2 sats dropped too low, and she was returned to her room with nursing notified for breathing tx’s. One pt reported BUE shoulder pain d/t OA.
By Calli Carlson, OTR/L, DOR, North Mountain Medical & Rehab, Phoenix, AZ
“Oh it’s just basic range of motion. That patient doesn’t require therapy anymore.” I’m embarrassed to think of how often I have said these words, and I wonder how many therapists may relate to this same perception.
Previously in our facility, patients who were non-responsive or minimally responsive were transitioned from our skilled physical and occupational therapy to restorative nursing programs for passive range of motion, typically for three days a week. Over time, we began to notice that patients were demonstrating difficulty maintaining their current range of motion, while restorative nursing was likewise reporting increased tone and increased difficulty working with our more medically complex patients.
For patients with complex brain and spinal cord injuries, hypertonicity can worsen with time causing an invariable decline in range of motion as well as increased difficulty for restorative members performing their range of motion treatments and increased difficulty for certified nursing assistants performing basic tasks such as dressing and peri care. With this in mind, the dialogue began to shift from therapy could be involved in these patient cases to therapy should be involved in these patients cases to provide the best possible outcomes and improve quality of life.
Given the depth of therapists’ schooling on anatomy, neuroanatomy, kinesiology, positioning, and modalities, it seemed that therapists could provide enormous benefit simply by increasing their involvement and time with these clinically complex patients while also educating and instructing restorative nursing assistants, certified nursing assistants, and additional floor staff as needed.
A physical therapist at North Mountain Medical Center, Shannon Dougherty, took initiative and recently developed a program titled, “No pressure, no pain, no problem,” focused on improving the health and quality of life of long-term care residents in the facility. The 3-part program encompasses the following:
Part 1: No Pressure: Reducing likelihood of pressure injuries through bed positioning Part 2: No Pain: Reducing pain through manual techniques, modalities, contracture management Part 3: No Problem: Identifying ‘problem’ patients and completing CNA/RNA training for improved techniques, removing burden from RNA for especially complex patients that require additional assist.
The program is currently just beginning here at North Mountain, but we have already been surprised and encouraged by results we have seen thus far. One of our patients, in particular, presents with significant hypertonicity and accompanying flexion of upper and lower extremities at rest, placing this patient at high risk of developing contractures without appropriate intervention. Restorative nursing members have reported that this patient is typically averse to passive range of motion and that they have difficulty knowing how to properly complete this task. A formal therapy evaluation and subsequent treatment sessions identified that this particular patient responds well to simple verbal/tactile cueing, gentle massage of the hypertonic muscles, slow and prolonged stretch, as well as stretching muscles in isolation rather than combing several stretches at once (such as hip/knee extension). Therapists have begun educating restorative nursing members on these techniques as well as analyzing non-verbal pain responses such as diaphoresis, increased flexion posturing, facial grimacing, or increased heart rate in order to provide the best quality, patient-centered care.
The plan of care may differ for individual patients. For example, therapy might decrease restorative nursing visits to two times per week and see that patient once or twice per week to supplement their treatments, or therapy might work with that patient five days per week and discontinue restorative nursing at that time while they work to get a baseline and treatment ideas to share with the rest of the staff. Regardless of the method and scheduling, it is important that therapists see the value of their knowledge and skillset, restorative nursing members feel empowered and capable when working with these patients, and patients receive the best quality of care to improve their health and well-being while under our umbrella of care.
By Angelica Reyes RN, DON and Paul Baloy OTD, OTR/L, DOR, The Hills Post Acute Care, Santa Ana, CA
What is a nursing & rehabilitation partnership? Nursing is defined as a collaborative care of individuals that promotes overall health and prevents illnesses. Rehabilitation is the process of restoring and regaining the lost skills caused by an illness or injury.
Although nursing and therapy are two different disciplines, when both work together harmoniously, they become an effective and powerful tool that is deemed vital to our residents’ health advancement and recovery.
At The Hills, nursing and rehab departments collaborate on a daily basis to be able to provide an individualized resident centered care plan. We have developed an effective fall management system, wherein nursing and rehab teams visit residents at bedside for a more direct and involved plan of care, and diligently analyze and discuss which interventions will benefit the resident the most. Other recommendations are also solicited from the other members of the interdisciplinary team and continuously evaluated for their effectiveness.
In addition, we have recently conducted a successful CNA skills fair with the help and support of our Resource team, that encompasses the “customer second, passion for learning, and celebration” of the CAPLICO values. This event, “We Got Skills at The Hills,” allowed us to revitalize and strengthen the skills set of our front liners and bedside care providers for a safer care experience of our residents. Our very own rehab team demonstrated and shared their expertise in transferring, positioning and lifting our residents using bio-mechanically correct and safe techniques and approaches.
We will always have the opportunity to excel individually. It is when we start believing and behaving differently—collaboratively and seamlessly working together—that the magic starts to happen, exponentially multiplying our successes to meaningfully change the lives of those we care for as we continue our quest in dignifying long term care in the eyes of the world.
Submitted by Lito Ortiz, Therapy Resource/DOR, Flagstone-Momentum, CA It’s my honor to present our newest Chief Therapy Officer, Daisy Aranguren, Director of Rehabilitation at The Orchard Post-Acute Care and Therapy Resource for Momentum. Daisy has been a strong therapy leader within the organization over the past 18 years. Daisy lives the Ensign Culture, and she is driven to help patients, her team, and others succeed and reach their potential. Daisy’s leadership and ownership have helped her and her team achieve incredible results. She’s been with us for 18 years.
Daisy is also one of the elite therapy leaders in the company who has attended the Therapy Summit. Daisy is an integral part of their IDT team. She promotes a positive culture and helps provide great evidence-based outcomes by promoting standardized tests and individualized care and providing the supporting documentation for justification of therapy services. Their therapy team has consistently achieved great clinical and financial outcomes. Orchard’s therapy turnover rate is one of the lowest in the company, and most of our therapists have been at Orchard for at least five years.
Daisy is also dual role DOR and therapy resource; she provides support to coordinate the educational trainings and company-sponsored courses for our therapists. Daisy provides regular updates and trainings to therapists at The Orchard regarding Medicare guidelines, regulations and state practices, and also completes therapist yearly skills checks. Daisy routinely attends company-sponsored trainings on culture, therapy program advancement, and leadership development. She is also working on her geriatric certification.
Submitted by Tamala Sammons, M.A., CCC-SLP, Therapy Resource
Whitney is passionate, dedicated, hard-working and an integral part of the team at Rosewood. She contributes to the success of Rosewood in a number of ways. She works closely and cooperatively with Nursing, MDS and the BOM to be on top of PDPM. In fact, she was very involved in trainings in 2019 in preparation for PDPM and has been integral in the PDPM process at Rosewood from the onset.
She has built a cohesive, creative and vibrant rehab team that serves the residents at Rosewood. Rosewood has traditionally had more of a skilled focus, but under Whitney’s leadership, they have balanced that out with a dramatic increase in their long-term care therapy over the past year. This was a definite goal for Whitney, and she provided education to her team and kept working with them to turn the flywheel of more LTC programming. The Rosewood Rehab team now routinely has a per non-skilled day part B revenue in excess of $30, demonstrating their creative and passionate ability to provide therapy services to their LTC family.
Whitney has identified other potential leaders within her rehab team and has enrolled them in the DORITO program to make sure that Rosewood has good bench strength in rehab leadership as well as providing the opportunity for personal growth for those therapists interested in potential leadership roles.
Whitney has also been an important and influential cluster partner. She is the rehab cluster leader for her cluster and has been very active in this role. She is very supportive of one of the more inexperienced rehab leaders in her cluster, making a pointed effort to identify leadership and personal development qualities for that person as well as all of the DORs in her group. She deliberately guides her cluster partners (and herself) to continually develop personally and professionally.
Whitney lives CAPLICO and makes sure to support everyone in her building. She cares deeply about people, both staff and residents. She does a great job with the rehab staff of balancing the values of Customer Second and Love One Another with Accountability and Ownership. She always does her best to work with and help her therapists improve, but on those rare occasions where someone is not willing or capable of growing, improving and being a good fit, she has the discipline to compassionately part ways with that therapist.
Whitney is a tremendous asset to Rosewood, the Lady Luck cluster and to the Idaho-Nevada market. We are lucky and proud to have her, and she has most definitely earned the honor of being named Chief Therapy Officer.
Submitted by Jon Anderson, DPT, Therapy Resource What a privilege I have to share and celebrate our newest CTOs (Chief Therapy Officers) in Keystone. The CTO designation is the highest designation a therapy leader in the organization can receive. It is a tall order to be in this elite club. Please join me in congratulating this elite group of Texas leaders!
Vanessa Munoz, Veranda Health & Rehab
Is Ensign in you? If there ever was someone who bled CAPLICO it would be Vanessa Munoz, TPM at Veranda Health & Rehab. She is a true embodiment of our CAPLICO culture. Vanessa began her employment at Veranda 10-plus years ago, starting as a contract PTA with Rehab Care, then eventually transitioning to an in-house therapist. She was the natural selection to lead the team when the previous CTO/DOR left to become an ED. Vanessa quickly caught on and became a driver and an integral part of the IDT team that facilitates the processes to keep the facility operating optimally; however, with that said, she is modest and attributes Veranda’s therapy team’s accomplishments to having the best people in the industry.
In fact, those that she leads commented on how well-supported they feel. She includes them in many decisions. Vanessa’s leadership has led to an extremely cohesive, well-functioning team that consistently produces high levels of efficiency and excellent patient outcomes. But how do you do all of that and do well on audits? Ask Vanessa: Veranda’s MSCA scores are solidly consistent here, too, and they have always been among the highest, culminating with the most recent one — a facility overall score of 98.95% and a remarkable Therapy score of 100%!
Covid was and has been hard for all of us, but Vanessa truly stepped up and led by example in putting in long hours and days, including nights/weekends doing triple duty as a leader, therapist and an assistant to nursing. She stepped in without being asked to help with nurse aide duties, filling in shifts to provide for the residents’ needs, demonstrating love and support by working alongside Nursing staff, and inspiring some of her staff to also help in this capacity. She celebrates her team’s accomplishments, both professional and personal — coordinating and participating in celebrations, birthdays, special accomplishments, holidays, and births. She has had team-building activities to keep her team united and with a common goal to dignify our residents’ lives. I could literally write a novel on Vanessa listing all of her accomplishments in the last 10+ years as an employee and leader at Veranda, but it can be best summated by Jason Hess, Veranda, CEO when querying about her CTO application: “She’s got my vote.” And she certainly has the vote of all who know and work with her.
Andy Cisneros, Westover Hills
Andy Cisneros, PTA, DOR joined us in 2016 via an acquisition at Legend Oaks West San Antonio as the DOR. While at Legend Oaks West San Antonio, Andy was a trailblazer in finding ways to improve length of stay while maintaining great outcomes with our managed care patients, helping to solidify their success with metrics that resulted in the facility being designated as a facility of choice. Andy was instrumental in introducing a new incontinence program, PTNM (percutaneous tibial neuromodulation), to the nursing home sector and was part of an initial pilot program to demonstrate its effective outcomes with the LTC population, which helped fuel this program being used all over the organization as a way to better treat incontinence. Beyond this facility, Andy took ownership in the cluster by ensuring no one missed a resource when capturing Medicaid CMI (case mix index), and the trainings/tools he developed resulted in a growth of >10% in the cluster of under-captured resources.
Andy is a champion in dignifying LTC in the eyes of the world, has helped initiate a number of new programs at his facility, and was one of the first in Keystone to implement the wildly popular therapeutic drumming program. In 2019, Andy left West San Antonio for a new challenge and transitioned to a new acquisition, Westover Hills. This transition allowed him to grow a new team and teach the meaning of CAPLICO to them, but the growth did not stop with just the team, because he took the challenge of growing himself as a leader. At Westover, Andy has taken ownership of assisting in the success of the building by helping in any capacity needed. He is not only the champion for the management of CMI and PDPM, but he also takes the reins in teaching others in the building on how to live CAPLICO culture. He and his therapy team have helped lead the charge in keeping the morale up for residents and staff throughout the entire COVID pandemic. “Work as though the survival of our organization depends on your continued success in your own operation. If we all do that, and help each other to succeed in spite of the challenges, we will not only survive, but we will thrive.” These are the words of Andy Ashton when he was discussing the challenges we are facing in this new COVID-19 world, and Andy Cisneros has operated the bulk of this year with those words resonating in him. He approaches the management of his metrics with that in mind, and is always looking for ways to jump the S-curve. So proud of you, buddy! Congratulations, Andy!
Jayna Owens, Legend New Braunfels
Some leaders dream about cutting edge, culture change, and progressive innovative treatments, and people like Jayna Owens, SLP, DOR, make dreams a reality. Jayna began working for Legend Oaks-New Braunfels in the fall of 2015 and began her journey with us when the building was acquired in 2016. Jayna was inspired by our core values of intelligent risk taking and passion for learning. She worked as the Speech Therapy team lead, moving up to ADOR, and later taking over as the Director of Rehab.
During this time, she took a special interest in long-term care programming and dementia design. Jayna was one of the first in our company to write multiple grants to fund her new therapy programs and vision of changing dementia care. Jayna and her team used grant funds to create and develop shadow boxes for every resident utilizing the Abilities Care Program, creating a Sensory Room with a therapeutic program across all disciplines, dining room dementia design with environmental modifications, and providing familiar landmarks in accordance with resident’s long-term memory to decrease wandering within the facility. She had the opportunity to study with some of the best dementia design specialists in the world at the University of Stirling in Scotland and apply that knowledge to her building and train other affiliates in dementia care. She has a passion for teaching and educating Keystone and the organization in long-term care programming, as she is a frequent speaker on the LTC Think Tanks.
Jayna’s 120-bed facility might not seem like it could support 25 full-time therapists, but due to the nudges and pushes with LTC program development that she has established, her team is equally as inspired and encouraged by the changes happening in dementia care and take pride in Legend Oaks-NB being a progressive leader in innovative long-term care. Way to go, Jayna! Congratulations!
Marci Williams, Wisteria Place
When Marci put her mind to becoming a Physical Therapist, it was no easy task. Already a mother to her precious son Braiden, born with special needs, she was set to leave Abilene and head to Dallas for her last clinical rotation. When Marci learned that Braiden would need to have major surgery and she would be needed at home, she changed her last clinical rotation from Dallas to Abilene and started her rotation at Wisteria in October of 2013. Wisteria became part of the Keystone family in January 2014, and Marci accepted a full-time PT position with Wisteria in Feb 2014. With less than two years of clinical experience, Marci was promoted to DOR at Wisteria, and she has been building and growing the department there ever since.
The shift from student to employee to director would have been a challenge for many, but Marci was up to the task, learning while she taught others. Marci has worked over the years to grow programs and build a team that she loves. Marci had to work hard to grow her team into what they are today; over the years, she has added staff to accommodate program growth, nearly doubling the size of the therapy team. She has seen multiple administration changes at Wisteria and has stepped up every time to assist the incoming leaders as they build rapport, establish systems, and seamlessly transition through grace and knowledge. She is humble yet extremely strong, not only functioning as the DOR of a thriving facility, but serving as a hybrid therapy resource as well for the past two years, providing guidance and support to all of our affiliates in West Texas.
In addition, Marci has specialty knowledge of Kinesio taping, wound care, and PTNM, presenting on the LTC think tank call for incontinence care and training others in her area. She continues to show results across multiple areas, from exceptional MSCA scores to market metrics. However, Marci is not afraid to show vulnerability when necessary for growth. In preparation for PDPM, as facilities across the nation were re-claiming the use of group treatments, Marci humbly admitted that this was an area she lacked knowledge in and reached out for help. The power of asking. Time and time again, Marci has humbly led with no claim to success other than results. Marci continues to grow and evolve, joining committees and asking for education to better serve her team and her cluster, and we are so proud to honor Marci and recognize her as Chief Therapy Officer!
Roohi Kapoor, Mason Creek
Please allow me to introduce you to Roohi Kapoor. She is a Physical Therapist by trade and supports our Mason Creek facility as the Director of Rehab. Roohi began as a staff PT at Misty Willow in 2017 before transitioning to become the DOR at Mason Creek in 2019. Before I can share the details of her achievements in her role as DOR, you must get a grasp of who she is beyond the role. Roohi is in the process of completing her transitional Doctorate in Physical Therapy. You would have no idea that she is balancing this level of academic growth on top of her many responsibilities. At the start of Roohi’s transition to DOR, she was challenged to grow long-term care programming and build cultural unity within the facility. To say she has accomplished that goal, and so many others, is an understatement. Yes, her metrics rank amongst the highest in the organization from PNSD, CPM, and Productivity, but the true measure of her success is the actionable execution of clinical programs. She empowers her OT and SLP to grow dementia care with purposeful intent, and she partners with her fellow PT to deliver PTNM (incontinence program).
Roohi’s rehab team was quite tenured before she joined, and they have welcomed her with open arms. Her reach is not limited to just therapy services; she has built a bridge between Therapy, Nursing and the entire IDT. Roohi will extend her support to her cluster and market partners without hesitation. She is able to create buy-in and excitement behind each of her ideas. Education and training is of her utmost importance, as she always wants her team to be ready for anything. Her near-perfect MSCA results are further evidence that she moves with precision and is very thoughtful in how she prepares her team. She is constantly searching to understand what/how she can enhance her skills, both clinically and operationally. It is with great joy that I can share that she will be continuing her professional growth by becoming an AIT. We are beyond proud that she has earned the coveted title of Chief Therapy Officer. Congratulations, Roohi!
Charlie Costa, Legend Garland
Charlie Costa, PT, is the DOR at Legend Oaks Garland. Upon acquisition, this facility was struggling, and unfortunately continued to do so for a while. But through all the struggles, the shining light was always Charlie and his Therapy team. While all other metrics were trending in the wrong direction, Therapy was steadily growing stronger and better. Charlie was able to truly balance the financial responsibilities of the facility and the clinical needs of the patients, and he has been instrumental to Garland’s rise to the top of the market. Charlie has a passion for marketing, and he can often be found working with nearby facilities, home health companies and doctor’s offices to help in census development. Charlie is always up for a challenge; he is the first to introduce a new initiative. When we re-introduced group and concurrent modalities of treatment, Charlie was one of the first in Keystone to train his team and really show us all what a difference this mode of efficiency can make. He was one of our first DORs to embrace the value of DOR treatment in building morale with his team, and he loves to train and mentor students; you never walk into the department without seeing someone learning something new.
Charlie loves to roll out new clinical programs for his residents, as evidenced by his Part B PNSD being consistently in the top 5, and by the smiles on the residents’ faces! If one were to look at therapy metrics, Garland is always in the top third of every metric, not only Part B PNSD, but also productivity, cost per minute, and margin percentage, all while being able to balance his ownership in the data with his love for his team and facility. Charlie’s culture in the facility can only be described as contagious, and in the words of his ED, Will Sherman, “Charlie brings a great energy to our team where there is accountability, but in a loving and fun approach, which is a bright spot in our facility … you really can hear Charlie’s laugh down the hall, and it just makes you smile, because he not only enjoys what he does, but he has the right passion in making sure our residents are cared for properly and manages things as if it were his own.” Amazing job, Charlie, and congratulations!
