Bennett Hills Rehab: Wheelchair Fall Injures Dialysis Resident - ID
The incident happened on December 27, 2025, at 8:12 in the morning. The resident, identified in inspection records only as Resident 8, was being transported back to Bennett Hills Rehabilitation and Care Center after a dialysis treatment. He reported neck pain after the fall and was sent to the emergency room for evaluation.
Federal inspectors reviewed the facility's own investigation during an April 30, 2026 survey. The facility had already concluded what went wrong. The straps connecting the front wheels of the wheelchair to the van's floor fixtures had not been properly connected and came loose during transport. The wheelchair tipped backward. The administrator told inspectors on April 28 that the driver "did not latch the front wheels of Resident 8's wheelchair and she should have."
Resident 8 was dependent on renal dialysis and had diabetes. He had been admitted to Bennett Hills on November 21, 2025, and readmitted shortly after. That meant he was a regular passenger in the facility's transport vans, making the round trip to dialysis treatments on a recurring schedule.
The facility's own transportation policy, revised the previous month, spelled out the requirement clearly: insert the four tie-down mechanisms into the floor fixtures, make certain they are secured and locked in. The fleet safety manual said employees were expected to operate vehicles safely to prevent injuries. Neither document was ambiguous. The driver did not follow them.
After the fall, the facility moved quickly. Maintenance inspected the van the same day and found no mechanical problems. Staff were retrained on wheelchair securement between December 30 and January 2. A laminated pre-departure checklist was created and placed in each van on January 2, 2026. The transportation policy was also revised that day, adding language about how staff should respond after an in-transport incident. Competency audits were scheduled weekly for four weeks, then monthly for four months, then quarterly.
The facility monitored Resident 8 for psychological harm and delayed physical injuries through January 2. Inspectors noted no further transport accidents involving the vans after that date. By the time of the April survey, the facility was considered in substantial compliance and no plan of correction was required.
The inspection finding was labeled actual harm, past non-compliance, meaning inspectors concluded the violation was real and caused injury, but had been addressed before they arrived.
What the record does not resolve is simpler than any of that: a man who relies on a machine to keep him alive, who has no choice but to get into that van several times a week, fell backward and hit his head because the person driving him did not finish the job of securing his chair.
The van continued running its routes. The checklist went up on the dashboard. Resident 8 went back to dialysis.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Bennett Hills Rehabilitation and Care Center from 2026-04-30 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 6, 2026 · Our methodology
Bennett Hills Rehabilitation and Care Center in Gooding, ID was cited for violations during a health inspection on April 30, 2026.
The incident happened on December 27, 2025, at 8:12 in the morning.
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.