Cedar Ridge Center: Care Plan Deficiencies - WV
Resident #111 began refusing medications on September 4, the day after admission to Cedar Ridge Center. The refusals continued for 70 days until federal inspectors arrived on November 13.
The medications included insulin for diabetes, losartan and metoprolol for high blood pressure, atorvastatin for high cholesterol, and dapagliflozin and metformin for diabetes management. The resident also refused divalproex and trazodone for depression, famotidine for acid reflux, and melatonin for sleep problems.
Federal regulations require nursing homes to develop comprehensive care plans that address residents' specific needs and behaviors. Staff must create measurable goals and interventions when residents consistently refuse treatment.
The facility's medication administration records and progress notes documented the "frequent" refusals throughout September, October, and into November. Yet no care plan existed to address the pattern.
On November 13, the same day inspectors arrived, staff finally added a focus to the resident's care plan. It read: "Resident/Patient is resistive to care related to: Alzheimer's Disease hx [history] of resisting care, refusing medications; combative with staff; at times will refuse male caregivers."
The entry contained no goals for reducing medication refusals. It included no specific interventions or strategies for staff to follow. It provided no timeline for reassessment.
The Director of Nursing acknowledged to inspectors that Resident #111 had not been "care planned timely for medication refusals." She offered no explanation for the 70-day delay.
The resident's Alzheimer's disease diagnosis appeared in facility records, but staff had not used this information to develop appropriate approaches for medication administration. Research shows that residents with dementia often respond better to specific techniques, timing adjustments, or different staff approaches when refusing medications.
The timing of the care plan entry raised additional concerns. Staff created the documentation on the exact day federal inspectors conducted their complaint investigation, suggesting the facility was responding to regulatory scrutiny rather than resident needs.
Medication refusals can have serious health consequences, particularly for residents managing multiple chronic conditions. Diabetes requires consistent medication management to prevent dangerous blood sugar fluctuations. Uncontrolled high blood pressure increases risks of stroke and heart attack. Depression medications help maintain mental health stability in vulnerable populations.
The inspection report noted that Resident #111 was "combative with staff" and sometimes refused male caregivers. These behavioral patterns could have informed targeted interventions if staff had developed a proper care plan when the refusals began.
Federal investigators found the deficiency had "potential for actual harm" and affected one resident in their survey sample. The facility maintained a census of 110 residents during the inspection period.
The complaint investigation revealed systemic failures in care planning processes. Staff documented medication refusals consistently but failed to translate that information into actionable strategies for improving medication compliance.
Nursing homes receive federal funding through Medicare and Medicaid programs, which require compliance with comprehensive care planning standards. Facilities must demonstrate they are meeting residents' individual needs through documented, measurable approaches.
The November 13 inspection was conducted in response to a complaint, though the specific nature of the complaint was not detailed in the report. Federal inspectors reviewed medication administration records, progress notes, and care plans as part of their investigation.
Cedar Ridge Center operates at 302 Cedar Ridge Road in Sissonville, serving residents in Kanawha County. The facility must submit a plan of correction to continue participating in federal health programs.
The Director of Nursing's acknowledgment that care planning was not timely suggests staff were aware of their obligations but failed to act on them for more than two months while a resident with Alzheimer's disease continued refusing critical medications without proper intervention strategies.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Cedar Ridge Center from 2025-11-13 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
CEDAR RIDGE CENTER in SISSONVILLE, WV was cited for violations during a health inspection on November 13, 2025.
Resident #111 began refusing medications on September 4, the day after admission to Cedar Ridge Center.
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.