Ketchikan Med Ctr: 10 Deficiencies Found - AK
Staff #71 had been discussing the [NAME] Lake picnic scheduled for July 18 with floor and activities staff, planning to bring Resident #5 and Resident #9, both diagnosed with dementia. When the administrator joined the conversation on July 18, she immediately prohibited their participation.
Staff #71 attempted to explain that both residents had routinely attended outings safely in the past. The administrator refused to reconsider. The residents missed the picnic.
The facility's own policies contradicted the administrator's blanket ban. The Activities Therapy policy, revised just four months earlier in March, specifically listed "early to advanced dementia including Alzheimer's" among the types of residents served. The policy promised "outings to community events" as part of meaningful activities that promote "dignity, respect and the well-being of each resident."
Another facility policy on resident dignity, updated in February, required staff to "assist resident to attend activities of their choosing."
The medical director confirmed both residents had wandering histories but emphasized their successful outing participation. During a September 9 interview, he stated they had "attended many outings in the past without concern" and would not require one-on-one supervision during community events.
"Caution was always needed," the medical director acknowledged, "but there was no rule that these residents couldn't attend outings."
The chief nursing officer admitted during a September 4 interview that she had heard staff concerns about the dementia outing ban but "did not know enough about the federal regulations at the time."
Federal inspectors found the administrator's prohibition violated residents' rights to participate in activities and maintain their dignity. The violation affected multiple residents and created potential for actual harm by unnecessarily restricting their community engagement.
Staff #71's account revealed the administrator's immediate and inflexible response when the outing was discussed. Despite explanations about the residents' safe participation history, the administrator maintained her position that residents with dementia diagnoses would never be permitted to leave the facility for community activities.
The timing highlighted the policy contradiction. The facility had revised its activities policy in March to explicitly include dementia residents in community outings, yet the administrator implemented a blanket ban just months later without medical justification.
Both residents had demonstrated their ability to safely participate in community activities over time. The medical director's assessment that they could attend outings without individual supervision suggested their dementia did not pose safety risks that would justify exclusion.
The administrator's declaration that the residents would "never leave the unit" went beyond the specific July picnic, indicating a permanent policy change implemented without consultation with medical staff or consideration of individual resident capabilities.
Federal regulations require nursing homes to provide activities that meet residents' interests and maintain their highest level of well-being. Blanket restrictions based solely on diagnosis, without individual assessment of safety or capability, violate these requirements.
The facility's February dignity policy explicitly required staff assistance for residents to attend "activities of their choosing." The administrator's ban prevented staff from fulfilling this policy requirement for residents who had previously chosen to participate in community outings.
Staff #71's unsuccessful attempt to advocate for the residents demonstrated the administrator's unwillingness to consider individual circumstances or past successful experiences. The conversation ended with a definitive prohibition that overrode both medical assessment and established facility practices.
The September inspection found this blanket restriction on dementia residents' community participation violated federal requirements for resident rights and dignity, affecting multiple residents at the 25-bed transitional care facility.
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 violations during a health inspection on September 9, 2025.
When the administrator joined the conversation on July 18, she immediately prohibited their participation.
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.