Latest reports, citations, and penalties from CMS data
The violation was classified at **Scope/Severity Level D**, meaning it was isolated in nature and did not result in documented actual harm....
Inspectors classified this deficiency at **Scope/Severity Level E**, indicating a pattern of noncompliance rather than an isolated incident....
The incident happened July 23, 2025, at Ketchikan Med Ctr New Horizons Transitional Care....
The citation, recorded under F0835, identified the level of harm as immediate jeopardy and noted that the violation affected a small number of residents....
The facility has **not submitted a plan of correction**....
The problem centered on the facility's Narcotic Count Sheet, a form used to track controlled substances across each shift....
The medical director role is responsible for implementing resident care policies and coordinating medical care throughout the facility....
The resident arrived with an open wound on the sacrum that staff documented only as "open wound" without any detailed assessment....
### What Adequate Pharmacy Services Require Federal regulations under 42 CFR §483.45 establish clear expectations for nursing home pharmacy services....
The facility, which also received **10 total deficiencies** during the same inspection, has not submitted a plan of correction....
This classification sits on the lower end of the federal enforcement scale but still represents a meaningful gap in resident safety protocols....
The incident at Claiborne Health and Rehabilitation Center came to light during a federal complaint investigation completed November 20....
## Why Adequate Pain Management Is a Federal Requirement Pain management in long-term care settings is not optional or discretionary....
The post included identifying details about the patient's daughter and mentioned that Resident #77 was experiencing pain and had a spinal issue....
When asked if he could remove the wrap, the resident shook his head no....
Resident #1 was supposed to receive all nutrition through a PEG tube and remain NPO — nothing by mouth....
When inspectors asked administrators how bedridden residents would access the postings, the Chief Nursing Officer simply nodded and acknowledged they couldn't....
When inspectors raised the issue, the MDS Coordinator confirmed the resident needed the mats....
The resident, identified in records as Resident #5, had been admitted with a history of repeated falls, difficulty walking, and seizures....
Colonial Park Rehabilitation and Nursing Center was supposed to draw blood on April 14 to check vancomycin levels in Resident #1....