The Social Services Director spoke with Resident 2 on September 9 and 10 about how the cluttered room posed dangers to both the resident and roommates.
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The resident had not used his BPAP mask since 6:00 AM but staff left it exposed on his nightstand when inspectors arrived at 8:34 AM.
"R6 goes two weeks without getting showers," the resident told federal inspectors during a complaint investigation completed December 30.
Federal inspectors discovered the medication error during a December 30 complaint investigation.
The medication error occurred on November 20 at Alexandria Care Center, where Licensed Vocational Nurse 1 administered guaifenesin at 4:56 a.m.
The son reported that his father had bruises on his right forearm and skin tears on both hands, and wanted to know what happened.
The violation occurred on December 30 at 8:39 a.m.
The November 14 incident involved two residents enrolled in the facility's behavioral program.
Resident 1 at Meadowbrook Post Acute was supposed to be checked every 30 minutes after her May 13, 2025 fall that sent her to the hospital with a head injury.
Columbia Crest Center denied readmission to a cognitively intact resident who used an electric wheelchair and required assistance with personal care.
Registered Nurse #30 entered Resident #26's room at 8:06 A.M.
The incident occurred December 4th at Lodi Creek Post Acute, where Resident 1's meloxicam was scheduled for 8:00 AM but not administered until 9:46 AM.