Autumn Lake Healthcare At Calvert Manor
AUTUMN LAKE HEALTHCARE AT CALVERT MANOR in RISING SUN, MD — inspection on May 26, 2026.
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
establish a grievance policy and make prompt efforts to resolve grievances.
that the facility failed to ensure a grievance resolution was implemented and maintained as evidenced
to Resident #12 after a grievance resolution mandated RN #23 would not provide care to the resident.
This was found to be evident in 1 (Resident #12) of 1 resident reviewed for grievances.The findings include:During telephone interview with Resident #12's family member on 5/20/2026 at 10:03 AM, the family member stated a grievance was filed with the facility in December 2025 regarding the care received by their family member (Resident #12) by RN #23.
The family member stated that they had complained to the facility multiple times regarding RN #23 and stated that the resolution to the grievance filed in December 2025 was that RN #23 was not to provide care to Resident #12 in any capacity. On 5/20/2026 at 10:45 AM, review of the grievance showed it was initiated by the facility on 12/31/2025 at 4:30 PM.
Under Corrective Action it stated, Nurse named in compliant is aware that he is to not treat resident per [daughter] request (routine care).
The decision issued was dated 1/5/2026 on grievance form and was signed by the facility's Social Worker (SW) #22.On 5/22/2026 at 7:25 AM, Resident #12's medical record was reviewed.
Under Resident #12's Medication Administration Record (MAR) and Treatment Administration Record (TAR), RN #23 had documented medication administration and/or assessments of Resident #12 on dates 1/9/2026, 1/19/2026, 2/8/2026, 2/12/2026, 4/23/2026, and 5/20/2026.Review of staffing assignment sheets on 5/22/2026 at 8:14 AM showed that RN #23 was assigned care of Resident #12 on 1/9/2026, 1/19/2026, 2/8/2026, 2/12/2026, 4/23/2026, and 5/20/2026.
Additional review of Resident #12's medical record including the care plan did not show documentation that Resident #23 was not to provide care to Resident #12.On 5/22/2026 at 10:00 AM, the original copy of the grievance maintained by the facility filed on 12/31/2025 was reviewed and confirmed under Corrective Actions that RN #23 was not to provide care to Resident #12 and the decision was dated 1/5/2026.On 5/22/2026 at 10:15 AM, surveyor concerns were addressed with the Director of Nursing (DON) and SW #22.
Both staff members confirmed that the grievance resolution was that RN #23 was not to provide care to Resident #12.
The staff members stated they believe RN #23 was verbally made aware of not being allowed to care for the resident.
The DON stated they were under the assumption that RN #23 was not providing care to Resident #12 since the date (1/5/2026) of the grievance resolution.
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.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
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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.