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Good Samaritan Larimore: Pressure Ulcer Failures - ND
The resident developed deep tissue injuries on both buttocks by September 25....
Latest reports, citations, and penalties from CMS data
The resident developed deep tissue injuries on both buttocks by September 25....
Federal inspectors discovered the missing Iowa Statutory Power of Attorney documents during a November 25 complaint investigation....
The resident at Center Point Health Care and Rehab had dropped from 139.4 pounds in late August to 128.8 pounds by mid-November....
The Director of Nursing confirmed to federal inspectors that staff had not been trained specifically on orthostatic hypotension fall prevention techniques....
"She rolled out of the bed on to her face," the aide said....
Inspectors documented the burn through a series of wound assessments....
What federal inspectors found when they arrived on November 20, 2025, was that the facility had not done what it said it would do....
The investigation, triggered by a complaint filed with regulators, resulted in **two deficiency citations** for the Arlington Heights nursing home....
The state ombudsman told inspectors she hadn't received any discharge notices from Agawam East Rehab and Nursing since March 2025....
Staff A started her 7:00 AM shift on October 19, 2025, and began checking rooms around 7:15 AM when she discovered Resident ID #1 missing from bed....
Among the citations, the facility failed to ensure residents' right to a safe, clean, and comfortable living environment....
The deficiency was classified at **Scope/Severity Level D**, meaning the violation was isolated in nature....
The violent altercation left the resident with a nasal fracture....
Medical records showed the patient was cognitively intact with a BIMS score of 13 out of 15....
The facility was given a correction timeline and reported the issue was resolved as of **December 18, 2025**....
During three days of inspections in November, investigators discovered the same pattern repeatedly....
Staff only called an ambulance after the granddaughter alerted them around 4:15 PM on September 3 that she was having trouble waking the resident up....
The owner of the independent living facility told inspectors the placement was inappropriate from the start....
The resident suffered a left hip fracture....
The resident, identified as R #24 in inspection records, had been in the dining room since 11:30 AM when inspectors found him at 1:55 PM on November 17....