Buena Vista Care Center: Wander Guard Testing Failures - CA
The gap was discovered during a complaint inspection completed October 3, 2025....
Latest reports, citations, and penalties from CMS data
The gap was discovered during a complaint inspection completed October 3, 2025....
The interview lasted until at least 3:55 in the afternoon....
It is not the lowest level of concern....
The resident's own care records flagged her as someone at elevated risk of falling....
That distinction matters less than it might sound....
A staff member walked through, didn't wait to hear the latch click, and kept walking....
The resident, admitted to the facility just weeks earlier in September 2025, received those medications from the contaminated cup....
Twenty-three minutes later, they came back....
Inspectors visited Cornerstone Nursing and Rehab Center on September 26, 2025, responding to a complaint....
This applied specifically, the sign noted, to wound care involving any skin opening that required a dressing....
The inspection was triggered by a complaint....
Inspectors from the Centers for Medicare and Medicaid Services visited the facility on October 10, 2025, following a complaint....
The deficiency was one of nine violations documented during the complaint inspection....
The inspection, completed September 30, 2025, was triggered by a complaint....
His admitting orders included Dilaudid, a potent opioid used to manage moderate to severe pain....
The violation fell under the category reserved for freedom from abuse, neglect, and exploitation deficiencies....
But inspectors determined there was potential for more than minimal harm to residents who went without a completed plan....
The resident, identified in inspection documents only as Resident #1, had been admitted to hospice care on August 11....
The incident happened September 13, 2025, on the South 2 locked unit....
Federal inspectors cited Bayshore Nursing & Rehab for exactly that failure during a complaint inspection completed September 30, 2025....