Autumn Lake Healthcare At Waugh Chapel
AUTUMN LAKE HEALTHCARE AT WAUGH CHAPEL in GAMBRILLS, MD — inspection on November 19, 2025.
Found 1 citation. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on complaint, reviews of a closed medical record, and staff interview, it was determined that the nursing staff failed to follow a physician's orders for withholding an antihypertensive medication when the resident's blood pressure reading was less than 110 mm/Hg.
This was evident for 1 of 2 residents (Resident #1) reviewed during the complaint survey.The findings include:Review of Complaint 2605041 on 11/19/25 at 12 noon revealed an allegation Resident #1 was not receiving quality of care at the facility.Resident #1 was admitted to the facility on [DATE] with diagnoses that include but are not limited to post vascular surgery, arthritis, and hypertension. Resident #1 requires assistance from the nursing staff for some aspects of his/her care.Review of Resident #1's closed medical record on 11/19/25 at 12 noon revealed a physician order, dated 08/09/25, instructing the nursing staff to administer the blood pressure lowering medication, Amlodipine Besylate oral tablet, 2.5 mg, by mouth, one time a day, and hold for a systolic blood pressure reading less than 110 mm/Hg.A review of Resident #1's August and September 2025 Medication Administration Records (MAR) revealed the nursing staff were administering a dose of Amlodipine Besylate at 9 AM when Resident #1 blood pressure readings were less than 110 mm/Hg on the following days:08/11/2025 - 109/74.08/12/2025 - 109/74.08/14/2025 - 106/70.08/25/2025 - 106/70.08/28/2025 109/70.09/04/2025 - 100/60.In an interview with Staff Nurse #1 on 11/19/2025 at 3:40 PM, after reviewing Resident #1's August and September MAR's, Staff Nurse #1 stated that s/he should have withheld administering the dose of Amlodipine Besylate, 2.5 mg orally, to Resident #1 on 08/11/25, 08/14/25, 08/25/25, 08/28/25, and 09/04/25 due to Resident #1's blood pressure reading was less than 110 mm/Hg.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.
For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.