Latest reports, citations, and penalties from CMS data
The failure to follow these protocols represents a breakdown in resident safety systems designed to protect vulnerable individuals....
When asked if he was choking, the resident nodded while struggling to breathe....
Additionally, the nurse documented administering a Mometasone Furoate inhaler that was never actually given to the resident....
When questioned, a certified nursing assistant acknowledged that placing all four side rails in the raised position constituted a restraint....
The inspection revealed that 26 of 27 residents did not receive proper screening to determine their eligibility for influenza and pneumonia vaccines....
During an initial facility tour on June 3, 2024, at 8:45 a.m., surveyors observed the resident lying in bed without the cervical collar....
Inspectors identified systemic failures in how staff assessed fall risks and communicated safety measures....
The investigation revealed a critical gap between the nursing home's monitoring procedures and actual care delivery....
The nurse subsequently admitted to borrowing the Lasix from another nurse - medication that belonged to a different resident entirely....
The facility had no RN staffing on December 2-3, 9-10, 16-17, 23-25, and 29-31, 2023....
The facility's medical provider ordered a venous doppler study, a diagnostic ultrasound procedure used to detect blood clots in veins....
Similar patterns emerged on Hall B, where staff touched privacy curtains, delivered food trays, and moved between resident rooms without hand hygiene....
Medical records serve as the primary communication tool among healthcare team members and provide the legal documentation of care delivered....
Elevated BNP levels indicate the heart is struggling to pump blood effectively, a critical finding in patients with known heart failure....
The resident had been at the facility since late November 2024, with a brief hospital stay in January....
During a medication pass beginning at 8:47 a.m....
## Overnight Staffing Raises Concerns The facility's nighttime staffing configuration emerged as a primary issue during an April 2025 inspection....
Federal regulations define manual restraint as holding or limiting a resident's voluntary movement through body contact....
This newly created assessment identified that staff education and competencies were necessary to support resident care needs, including various certifications....
Additionally, the facility failed to develop individualized care plans addressing smoking activities for residents who smoked....