Ketchikan Med Ctr: Abuse Protection Failures - AK
The prohibition occurred during planning for a July 18 picnic at a local lake, when Staff #71 and other employees were discussing bringing Resident #5 and #9, both diagnosed with dementia, on the outing.
The Administrator emerged from her office and joined the conversation. She stated "Absolutely not" and declared that these residents would never leave the unit.
Staff #71 attempted to explain that both residents had routinely participated in outings without incident and that excluding them would be inappropriate. The Administrator refused to reconsider.
The residents were barred from attending the picnic.
During a September 4 interview, the facility's Chief Nursing Officer acknowledged hearing staff concerns about the dementia outing ban but stated she "did not know enough about the federal regulations at the time."
The Medical Director contradicted the Administrator's blanket prohibition during a September 9 interview. While acknowledging that Resident #5 and #9 had histories of wandering, the Medical Director confirmed they had "attended many outings in the past without concern" and would not require one-on-one supervision during community activities.
"Caution was always needed, but there was no rule that these residents couldn't attend outings," the Medical Director stated.
The exclusion violated the facility's own written policies. The Activities Therapy Scope of Service policy, revised March 6, specifically identifies residents with "early to advanced dementia including Alzheimer's" as appropriate participants in activities programming.
The policy commits to providing "meaningful and age appropriate activities that engage each resident while promoting dignity, respect and the well-being of each resident." It explicitly includes "outings to community events" among the services offered.
The facility's Resident Dignity Policy, revised February 18, requires staff to "assist resident to attend activities of their choosing" as part of maintaining residents' self-esteem and self-worth.
Federal inspectors found the Administrator's blanket ban violated regulations requiring facilities to provide activities designed to meet the interests and physical, mental, and psychosocial well-being of each resident.
The violation affected multiple residents and created potential for actual harm by denying appropriate therapeutic activities based solely on dementia diagnoses rather than individual assessment.
Staff #71's account revealed the Administrator's decision was made without consulting the Medical Director or reviewing the residents' individual care plans and outing histories. The prohibition appeared to stem from general concerns about dementia rather than specific safety assessments for these particular residents.
The contradiction between the Administrator's absolute ban and the Medical Director's approval highlighted internal disagreements about appropriate care for residents with cognitive impairments.
The facility's policies explicitly recognize residents with dementia as appropriate candidates for community outings when properly planned and supervised. The Activities Therapy policy acknowledges serving residents with dementia ranging from early to advanced stages.
Both residents had demonstrated their ability to safely participate in community activities through their previous outing attendance. The Medical Director's assessment that they did not require individual supervision further supported their continued participation.
The Chief Nursing Officer's admission that she lacked knowledge about federal regulations governing resident activities suggested broader staff education gaps about appropriate dementia care practices.
Federal regulations require nursing homes to provide activities that promote each resident's highest practicable level of physical, mental, and psychosocial well-being. Blanket exclusions based on diagnosis rather than individual assessment violate these requirements.
The lake picnic exclusion denied Resident #5 and #9 the therapeutic benefits of community engagement and social interaction that their previous outing participation had provided safely.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Ketchikan Med Ctr New Horizons Transitional Care from 2025-09-09 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
KETCHIKAN MED CTR NEW HORIZONS TRANSITIONAL CARE in KETCHIKAN, AK was cited for abuse-related violations during a health inspection on September 9, 2025.
The Administrator emerged from her office and joined the conversation.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.