Federal inspectors discovered the violation during a September inspection of the 32-bed facility.
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On August 17, R1's physician ordered Azithromycin tablets for pneumonia treatment.
Federal inspectors discovered the grooming neglect during a September complaint investigation at Ayden Healthcare of Waterville.
The resident, identified only as Resident #23, was admitted for rehabilitation and management of chronic health conditions.
The breakdown at Estherville Community Care Center left the resident vulnerable to pneumococcal disease for months.
But documentation showed no wound care occurred on September 6, September 7, September 20, and September 21.
The inspection, conducted September 26, 2025, identified violations serious enough to pose immediate danger to resident health and safety.
State inspectors found the hygiene failures during a September complaint investigation at Sinking Spring Skilled Nursing and Rehabilitation on Windmill Road.
The incident occurred at Winter Garden Rehabilitation and Nursing Center when nursing staff failed to arrive on time for dinner service.
Federal inspectors discovered the violation during a complaint investigation in September.
The resident, identified as #164, entered the facility on an unspecified date in March.
The incident occurred in the early morning hours of September 16.