The resident, identified in inspection records only as Resident R3, could not speak.
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Inspectors arrived the next day.
That was one of several admissions inspectors collected on August 12, 2025, during a complaint inspection at the skilled nursing facility.
The inspection, conducted on August 12, 2025, caught the problem during a routine review of one of two medication carts at the facility.
The resident, identified in inspection records only as R5, uses an indwelling urinary catheter because of a neuromuscular dysfunction of his bladder.
Resident R1, a man with chronic kidney disease, urinary retention, and a freshly placed urinary catheter, was alone.
What happened next became the subject of a complaint, a facility investigation, and ultimately a federal inspection citation.
The facility opened it before he ever saw it.
That was not the first time inspectors had seen the insects that week.
That was not the worst thing inspectors found that week.
That detail came from an interview inspectors conducted on August 12, at 10:22 in the morning.
Inspectors arrived on August 12 and spent nearly two hours observing the first floor nursing unit.