Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 7 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
2G
0H
0I
Potential for more than minimal harm
2D
2E
1F
Potential for minimal harm
0A
0B
0C
October 19, 2022Standard inspection · 6 citations
- G
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Inspectors wroteBased on facility policy review, facility documentation review, medical record review, hospital record review, and interviews, the facility failed to implement care plan interventions for 3 of 12 sampled residents (Resident #30, Resident #50, and Resident #75) reviewed for falls with injury which resulted in actual harm. Resident #30 had a laceration, bruising and bump to the head that required one staple. Resident #50 had a contusion to right hip and shoulder. Resident #75 had a left forehead laceration, approximately 5 mm [millimeter] requiring steri-strips with an acute traumatic subdural hematoma).
- G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on facility policy review, facility documentation review, medical record review, and interviews, the facility failed to protect 3 of 12 sampled residents (Resident #30, Resident #50, and Resident #75) reviewed related to falls with injury which resulted in actual harm (Resident #30 had a laceration, bruising and bump to the head that required one staple. Resident #50 had a contusion to right hip and shoulder. Resident #75 had a left forehead laceration, approximately 5 mm [millimeter] requiring steri-strips with an acute traumatic subdural hematoma).
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observation and interview the facility failed to maintain dietary equipment in a sanitary manner for 1 of 3 observations in the dietary department.
- E
Provide and implement an infection prevention and control program.
Inspectors wroteBased on facility policy review, medical record review, observation, and interview the facility failed to prevent the spread of infection for 3 of 21 residents (Resident #27, Resident #53, and Resident #58) related to proper storage/sanitation of nebulizer equipment and failed to maintain dietary equipment in a sanitary manner for 1 of 3 observations in the dietary department related to pink debris in the ice machine where ice was kept.
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on facility policy review, medical record review, and interview, the facility failed to revise a care plan for 1 of 37 sampled residents (Resident #7) reviewed for weight loss.
- D
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Inspectors wroteBased on facility policy review, procedure manual review, medical record review, observation, and interview, the facility failed to label and date enteral feeding for 1 of 4 residents (Resident #231) requiring enteral feedings.
October 9, 2019Standard inspection · 1 citation
- E
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications were stored securely and safely when 2 of 3 (Licensed Practical Nurse (LPN) #1 and #2) nurses left medications out of site and unattended.
November 28, 2018Standard inspection · 0 citations
Fire safety inspections
2 fire safety citations on file: 1 on October 9, 2019, 1 on November 28, 2018.
Every fire safety citation2 citations
- D
Keep aisles, corridors, and exits free of obstruction in case of emergency.
K 211 · October 9, 2019 · Corrected (the home has a date of correction)
- D
Inspect, test, and maintain automatic sprinkler systems.
K 353 · November 28, 2018 · Corrected (the home has a date of correction)