Nursing Home News — Page 958

The assaults targeted Residents #9, #13, and #14, all of whom had documented diagnoses of dementia and Alzheimer's disease.

The incident occurred on March 16, 2025, when the resident attempted to plug in her phone charger.

A registered nurse located him after hearing running water in the female resident's room.

The resident's medical record indicated a diagnosis of quadriplegia and dependence on an indwelling urinary catheter for bladder management.

Annual background screening serves as a critical safeguard in long-term care settings.

Posted schedules for January 25 showed only eight CNAs working the morning shift, six on the evening shift, and four during the overnight hours.

This represented a 7.01% weight loss, exceeding the clinical threshold of 5% that triggers heightened monitoring and intervention.

## December Immediate Jeopardy Period An immediate jeopardy situation occurred at the facility beginning December 20, 2024.

## Federal Oversight Process The Centers for Medicare & Medicaid Services conducted a complaint investigation at the facility on July 12, 2024.

to arrive for treatments beginning at 4:15 a.m.

This documentation failure revealed a systemic breakdown in the facility's ability to track resident whereabouts.

However, staffing records showed they were consistently short by 0.5 to 1 CNA across multiple shifts.