Nightingale Nursing and Rehab: IV Antibiotic Failures - PA
The resident, identified in inspection records as Resident R3, was living at Nightingale Nursing and Rehab Center on East 26th Street with a list of serious diagnoses: subarachnoid hemorrhage, seizures, a stage 4 pressure ulcer over the sacral region, and osteomyelitis, a bone infection that can spread and become life-threatening without consistent treatment.
On October 18, 2025, a physician ordered Daptomycin, an IV antibiotic, to be administered at 725 milligrams every afternoon. The order was specific: 50 milliliters delivered by IV piggyback, infused at 129 milliliters per hour over 30 minutes, starting that same day at 2:00 p.m., running through October 31.
The medication was not given on October 18. It was not given on October 19. It was not given on October 20.
Nothing in the clinical record, including the medication administration record, showed any evidence the doses were administered on any of those three days.
Resident R3 was not the only patient affected. A second resident, identified as Resident R2, had a physician's order for Cefepime, another IV antibiotic, that also went unfollowed. Inspectors found the same problem in that resident's records: orders written, doses not documented, no evidence the medication reached the patient.
On October 23, the Director of Nursing sat down with inspectors and confirmed both failures directly. The physician's orders for IV antibiotic administration had not been followed for either resident. The clinical records for both Resident R2 and Resident R3 lacked evidence that the prescribed IV antibiotics had been given. The Director of Nursing confirmed it.
The inspection, conducted as a complaint investigation, was completed November 25, 2025. CMS assigned the violation under F0684, which covers the standard that residents receive care in accordance with professional standards of practice. The level of harm was assessed as minimal harm or potential for actual harm, with some residents affected.
That harm classification reflects regulatory language, not necessarily clinical reality. Osteomyelitis is a serious infection. Daptomycin is typically prescribed when an infection is severe enough to require intravenous treatment rather than oral antibiotics. Missing three consecutive afternoon doses of an IV antibiotic prescribed for a bone infection in a resident who also had a stage 4 pressure ulcer reaching into muscle and bone is not a paperwork problem. It is a gap in treatment for someone already carrying one of the most serious wound classifications that exists in long-term care.
A stage 4 pressure ulcer, by definition, has broken through skin and tissue down to muscle, tendon, ligament, cartilage, or bone. In Resident R3's case, the wound was located at the sacral region, the triangular bone at the base of the spine. Osteomyelitis in that area, in a patient with that kind of wound, is a recognized and dangerous complication.
Whether Resident R3's condition worsened during those three days, the inspection report does not say. What it says is that the medication ordered to treat the infection was not given, the records showed no evidence it was given, and the Director of Nursing confirmed it.
Nightingale Nursing and Rehab Center is a 120-bed facility. The inspection report does not describe any corrective action taken between the dates the doses were missed and the date inspectors arrived, nor does it describe what, if anything, was done for Resident R3 once the gap was identified.
The physician's order had been written. The medication had been prescribed. Somewhere between the order and the patient, on three consecutive afternoons, nothing happened.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Nightingale Nursing and Rehab Center from 2025-11-25 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
NIGHTINGALE NURSING AND REHAB CENTER in ERIE, PA was cited for violations during a health inspection on November 25, 2025.
On October 18, 2025, a physician ordered Daptomycin, an IV antibiotic, to be administered at 725 milligrams every afternoon.
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.