Nursing Home News — Page 145

The August 22 complaint inspection turned up the care planning failure under a category regulators call Resident Assessment and Care Planning Deficiencies.

The inspection report did not document that any resident was actually harmed, but inspectors determined there was potential for more than minimal harm.

The inspection report describes a specific protocol that was not being followed.

One of those deficiencies cut to the center of what a nursing home is supposed to do.

That phrase, "potential for more than minimal harm," is the floor of what triggers a formal citation.

The two men, identified in inspection records as Resident #2 and Resident #4, shared a room at the facility.

When inspectors sat down with the Director of Nursing on the morning of August 23, she confirmed both.

The inspection, completed August 25, 2025, was triggered by a complaint.

Level D is not a paperwork problem.

Potential for more than minimal harm.

It also found the facility had not properly employed or obtained the services of a licensed pharmacist.

The August 23 complaint inspection produced an Immediate Jeopardy finding under F0689, the federal standard governing accident hazards and resident safety.