Resident #3, who is cognitively intact, shouted for help until the Assistant Director of Nursing came to the dining room.
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When inspectors asked whether wound assessment fell within an LPN's scope of practice, Staff E responded: "I never really thought of that, I am not sure.
The complaint investigation at Willard Care Center revealed a pattern of undocumented family communications across multiple residents.
Federal inspectors who watched nurses distribute medications over two days in November found a 7.14% error rate on the facility's first and second floors.
The resident told investigators that CNA #2 became upset when asked to be gentler during care on August 21, 2025.
The October 29 incident involved a resident who had been admitted just days earlier with congestive heart disease, anxiety, and Type 2 diabetes.
State inspectors found the violations during a November 14 visit to Aperion Care Midlothian.
Resident 9 sat on the edge of their bed without a call light within reach on November 14.
The specific nature of the violations was not detailed in available inspection records.
Business Office Manager #120 used Resident #67's money to purchase a Samsung Galaxy Book 3 Pro laptop for $2,359.09, addressed to the manager at the facility.
The November 17 incident involved Resident 67, a patient with severe cognitive impairment who depends on multiple medical devices to survive.
The resident, identified as Resident #100, lived in an independent living apartment before his stay at the nursing facility.