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Complaint Investigation

Pine Creek Rehabilitation And Nursing

October 9, 2025 · Salt Lake City, UT · 876 West 700 South
Citations 2
CMS Rating 3/5
Beds 34
Provider ID 46A064
Healthcare Facility
Pine Creek Rehabilitation And Nursing
Salt Lake City, UT  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

Pine Creek Rehabilitation and Nursing in Salt Lake City, UT — inspection on October 9, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0602
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Potential for More Than Minimal Harm

an interview was conducted with the ADM.

The ADM stated that he was not the ADM when the incident with resident 38 had occurred.

The ADM stated he called the prior ADM and was told that he had not been completely in the loop regarding that incident.

The ADM stated that the prior ADM spoke with corporate staff and was told to pay resident 38 back the money that was taken.

The ADM stated that was all the prior ADM could say.

The ADM stated that yes he would have called local law enforcement and reported the allegation.

The ADM stated that he would investigate the allegation by speaking with the individual and the resident.

The ADM stated that he would have assessed how the resident was doing.

The ADM stated that he would have completed the typical investigation stuff and he would have asked for the money back from the individual that took it.

The ADM stated that he had a curriculum of training that he presented at the all staff monthly meetings.

The ADM stated that abuse was presented twice a year.

The ADM stated if there was a unique case he would bring abuse up again.

The ADM stated there was no training that he could find regarding the incident with resident 38.

Facility ID:

46A064

IDENTIFICATION NUMBER:

46A064

A.

Building

COMPLETED

10/09/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Pine Creek Rehabilitation and Nursing

876 West 700 South Salt Lake City, UT 84104

SUMMARY STATEMENT OF DEFICIENCIES

Findings included: Resident 38 was admitted to the facility on [DATE] with diagnoses which included, but were not limited to, chronic obstructive pulmonary disease, generalized anxiety disorder, and adjustment disorder with mixed disturbance of emotions and conduct. Resident 38's medical record was reviewed.

The facility Incident Report Form was reviewed. On 3/4/25 at 1:37 PM, resident 38 reported that she had learned that the (Nursing Assistant) NA was having some struggles financially and resident 38 offered to give the NA $100.00 to help.

After multiple attempts resident 38 finally forced the funds in the NA's pocket and the NA accepted the funds.

After a few days resident 38 texted the NA asking for the $100.00 back so resident 38 could pay for some personal storage expenses.

The NA did not respond to resident 38 and resident 38 reported the issue to two different staff members to ask for help.

The alleged perpetrator statement dated 3/4/25 at 1:00 PM, documented that the NA was talking to resident 38 about her financial situation and talking about life.

After resident 38 found out that she was struggling a little bit, resident 38 offered her $100.00 to help get her by.

The NA reported that she did not accept the money at first but after she kept pressing and put the money in her pocket she kept the money.

The NA reported that she did not know it was not allowed.

The employee was terminated and the facility verified the allegation.

The APS report included with the facility investigation was submitted on 3/21/25 at 1:51 PM.

The facility Alleged Resident Abuse/Neglect Investigation Checklist documented Notification of Police was not applicable. On 10/8/25 at 11:22 AM, an interview was conducted with the Resident Advocate (RA).

The RA stated that she did not currently work at the facility but she was the RA when she did.

The RA stated that she was informed that resident 38 let a NA borrow $100.00, and the NA had not paid it back.

The RA stated that resident 38 had no changes in behavior.

The RA stated that she notified the Administrator (ADM) and Director of Nursing once she became aware of the incident.

The RA stated that she did not help with investigating incidents.

The RA stated that abuse training was provided to staff twice a year and the training included signs and symptoms of abuse, who to report allegations to, and the time frame of reporting. On 10/8/25 at 1:22 PM, an interview was conducted with the ADM.

The ADM stated that he was not the ADM when the incident with resident 38 had occurred.

The ADM stated he called the prior ADM and was told that he had not been completely in the loop regarding that incident.

The ADM stated that the prior ADM spoke with corporate staff and was told to pay resident 38 back the money that was taken.

The ADM stated that was all the prior ADM could say.

The ADM stated that yes he would have called local law enforcement and reported the allegation.

The ADM stated that he would investigate the allegation by speaking with the individual and the resident.

The ADM stated that he would have assessed how the resident was doing.

The ADM stated that he would have completed the typical investigation stuff and he would have asked for the money back from the individual that took it.

The ADM stated that he had a curriculum of training that he presented at the all staff monthly meetings.

The ADM stated that abuse was presented twice a year.

The ADM stated if there was a unique case he would bring abuse up again.

The ADM stated there was no training that he could find regarding the incident with resident 38.

Facility ID:

46A064

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Salt Lake City, UT, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Pine Creek Rehabilitation and Nursing or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.