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Morning Star Post Acute: Physician Notification Failures - CA
At Morning Star Post Acute in Clovis, federal inspectors found that clock was being ignored....
Latest reports, citations, and penalties from CMS data
At Morning Star Post Acute in Clovis, federal inspectors found that clock was being ignored....
The inspection report documents what inspectors found when they looked closely: full garbage cans, odors in resident bedrooms, stains on resident sheets....
That was the finding at Desert Cove Nursing Center on West Frye Road when federal inspectors arrived on September 19, 2025....
That resident, identified as R6 in federal inspection records, later told surveyors the experience made them feel helpless....
The wound had been there for weeks....
The fall happened at approximately 1:30 AM....
The surveyor noted that she was crying....
The facility had no one else designated to fill it....
That admission came during a complaint inspection on September 24, 2025, when federal surveyors visited the 265-bed facility at 1300 County Farm Road....
Inspectors assigned the highest level of harm designation available under federal oversight: immediate jeopardy to resident health or safety....
When inspectors arrived at Envive of Sullivan on September 29, 2025, they were responding to a complaint....
Federal inspectors visited the facility on September 30, 2025, responding to a complaint....
They just didn't know what to look for....
R11 wanders every day and rejects care....
Inspectors documented the failure following a complaint investigation completed September 30, 2025....
The "many residents affected" designation is not a bureaucratic formality....
Federal inspectors cited Waters of Georgetown following a complaint inspection completed September 26, 2025....
The next afternoon, black flies were circling the kitchen while staff prepared pureed and mechanical soft meals for the dinner service....
That same day, the nursing assistant was suspended pending the outcome....
The administrator decided that hadn't happened either....