Deficiencies per Year
16
12
8
4
0
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Plan of Correction
Deficiencies: 0
Jul 1, 2025
Visit Reason
An off-site desk audit was conducted on July 1, 2025, to review all previous deficiencies cited on May 8, 2025.
Findings
Based on an acceptable plan of correction and supporting documentation, all deficiencies have been corrected and the facility is in compliance with all regulations surveyed.
Inspection Report
Plan of Correction
Deficiencies: 0
Jun 30, 2025
Visit Reason
An off-site desk audit was conducted on June 30, 2025, to review all previous deficiencies cited on May 7, 2025.
Findings
Based on an acceptable plan of correction and supporting documentation, the previously cited deficiencies have been corrected. The facility is in compliance with all regulations surveyed.
Inspection Report
Renewal
Census: 42
Capacity: 60
Deficiencies: 12
May 8, 2025
Visit Reason
A recertification survey was conducted from 5/5/2025 through 5/8/2025 to determine compliance with 42 C.F.R. Part 483, requirements for Long Term Care Facilities, including state licensure and emergency preparedness surveys.
Findings
Deficiencies were identified related to protection/management of personal funds, treatment and services to prevent/heal pressure ulcers, nutrition/hydration status maintenance, labeling and storage of drugs and biologicals, menu and nutritional adequacy, food procurement and safety, employee immunization and screening, life safety code compliance including fire safety and electrical systems. Plans of correction were filed for all deficiencies with specified completion dates.
Severity Breakdown
SS=B: 1
SS=D: 5
SS=F: 6
Deficiencies (12)
| Description | Severity |
|---|---|
| Protection/Management of Personal Funds - Facility failed to obtain written authorization for residents whose personal funds were held by the facility. | SS=B |
| Treatment/Services to Prevent/Heal Pressure Ulcer - Facility failed to ensure proper treatment and hand hygiene for residents with pressure ulcers. | SS=D |
| Nutrition/Hydration Status Maintenance - Facility failed to maintain acceptable nutritional parameters and follow weight monitoring policy. | SS=D |
| Label/Store Drugs and Biologicals - Facility failed to store and label drugs and biologicals properly in medication carts. | SS=D |
| Menus Meet Resident Needs/Preparation in Advance/Followed - Facility failed to provide a diet menu meeting nutritional needs per national guidelines. | SS=F |
| Food Procurement, Store, Prepare, Serve-Sanitary - Facility failed to ensure food safety and sanitary handling in kitchen and meal service. | SS=F |
| Personnel - Employee Immunization & Screening - Facility failed to ensure newly hired employees had evidence of required immunizations and screenings. | SS=D |
| Cooking Facilities - Facility failed to maintain kitchen hood suppression system per NFPA standards. | SS=F |
| Fire Alarm System - Testing and Maintenance - Facility failed to maintain fire alarm system and conduct required testing. | SS=F |
| Sprinkler System - Maintenance and Testing - Facility failed to maintain automatic sprinkler system per NFPA standards. | SS=D |
| Fire Drills - Facility failed to provide evidence of quarterly fire drills conducted on all shifts. | SS=D |
| Electrical Systems - Essential Electric System - Facility failed to maintain emergency power supply system generator and conduct required testing. | SS=F |
Report Facts
Capacity: 60
Census: 42
Deficiencies cited: 12
Weight loss percentage: 8.5
Weight loss percentage: 7.74
Weight loss percentage: 5.5
Weight loss: 15.2
Weight loss: 12
Weight loss: 5
Plan of correction completion dates: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Susan Miller | Administrator | Signed the plan of correction on 6/3/25 |
| Staff A | Observed failing to perform hand hygiene and apply correct dressing to resident wound | |
| Staff B | Registered Nurse | Unable to provide evidence of missing weights |
| Staff D | Registered Dietitian | Authored progress notes on resident weight loss |
| Staff F | Cook | Observed handling food without gloves |
| Staff G | Nursing Assistant | Reviewed for immunization and screening deficiencies |
| Staff H | Nursing Assistant | Reviewed for immunization and screening deficiencies |
| Staff I | Dietary Staff Member | Reviewed for immunization and screening deficiencies |
| Staff J | Food Service Director | Reviewed for immunization and screening deficiencies |
| Staff K | Reviewed for immunization and screening deficiencies | |
| Staff L | Dietary Staff Member | Reviewed for immunization and screening deficiencies |
Inspection Report
Life Safety
Deficiencies: 0
Aug 30, 2024
Visit Reason
A follow-up visit to a previous Life Safety Code survey was conducted at this facility.
Findings
All previous deficiencies were corrected and no new deficiencies were identified during this follow-up survey.
Inspection Report
Re-Inspection
Deficiencies: 1
Jun 26, 2024
Visit Reason
A revisit survey was conducted on June 26, 2024, to verify correction of previous deficiencies cited on the May 22, 2021, Re-certification/Licensure Life Safety Code survey.
Findings
Most deficiencies have been corrected, but the facility remains non-compliant with sprinkler system installation requirements per NFPA 101 Life Safety Code and NFPA 13 standards. The vendor has not yet replaced mixed sprinkler types in multiple areas, with ongoing plans for correction.
Deficiencies (1)
| Description |
|---|
| Sprinkler system or components do not meet installation requirements according to NFPA 101 Life Safety Code and NFPA 13 standards, with mixed sprinkler types present in several areas. |
Report Facts
Residents potentially impacted: 46
Dates of vendor sprinkler review: Vendor conducted sprinkler type review on 6/12/24, 7/3/24, and 7/5/24
Planned substantial compliance date: Substantial compliance expected by 7/14/2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Susan Miller | Administrator | Interviewed regarding ongoing vendor scheduling and sprinkler system corrections |
| Maintenance Director | Present during surveyor observations of sprinkler deficiencies |
Inspection Report
Follow-Up
Deficiencies: 0
Jun 24, 2024
Visit Reason
A follow-up to a previous recertification survey was conducted at this facility on 06/24/2024.
Findings
All previous deficiencies were corrected and no deficiencies were identified during this follow-up survey.
Inspection Report
Annual Inspection
Census: 46
Capacity: 60
Deficiencies: 16
May 22, 2024
Visit Reason
An annual Federal Life Safety Code survey and a Recertification Survey were conducted at Apple Rehab Clipper to determine compliance with 42 CFR Part 483 requirements for Long Term Care Facilities and National Fire Protection Association 101 Life Safety Code standards.
Findings
Deficiencies were identified at the substandard quality of care level including issues with safe environment, comprehensive care plans, professional standards, infection control, medication management, employee immunization, and life safety code compliance. Plans of correction were filed with substantial compliance expected by June 22, 2024.
Severity Breakdown
Level C: 1
Level D: 7
Level F: 6
Deficiencies (16)
| Description | Severity |
|---|---|
| Safe/Clean/Comfortable/Homelike Environment - Facility failed to ensure the front entrance door had an automatic door opener for handicap accessibility. | — |
| Develop/Implement Comprehensive Care Plan - Facility failed to implement a comprehensive person-centered care plan for a resident with lower leg edema. | Level D |
| Services Provided Meet Professional Standards - Facility failed to ensure residents received treatment and services in accordance with professional standards for weekly body audits. | Level D |
| Bowel/Bladder Incontinence, Catheter, UTI - Facility failed to provide appropriate treatment and services for a resident with an indwelling catheter including documentation of urinary output. | Level D |
| Nutrition/Hydration Status Maintenance - Facility failed to maintain acceptable parameters of nutritional status and weight monitoring for residents. | Level D |
| Nurse Aide Perform Review-12 hr/yr In-Service - Facility failed to complete annual performance review and provide regular in-service education for nursing assistants. | Level F |
| Drug Regimen Review, Report Irregular - Facility failed to ensure pharmacy medication regimen reviews were completed for residents and failed to educate staff on medication regimen review. | Level D |
| Label/Store Drugs and Biologicals - Facility failed to properly label and store drugs and biologicals including medication expiration dates. | Level D |
| Infection Prevention and Control - Facility failed to establish and maintain an infection prevention and control program including proper disinfection of blood glucose monitors. | Level D |
| QAPI Training - Facility failed to provide mandatory Quality Assurance Performance Improvement training to all staff. | Level C |
| Personnel Employee Immunization and Screening - Facility failed to obtain evidence of immunity for all health care workers and failed to provide required immunizations and screenings. | — |
| Fire Alarm System - Testing and Maintenance - Facility failed to maintain and test the fire alarm system in accordance with NFPA standards. | Level F |
| Sprinkler System - Maintenance and Testing - Facility failed to maintain and test the automatic sprinkler system and standpipe systems as required. | Level F |
| Fire Drills - Facility failed to conduct fire drills at varied times and shifts as required. | Level F |
| Maintenance Inspection and Testing - Doors - Facility failed to maintain smoke, fire, and exit doors in accordance with NFPA standards. | Level F |
| Electrical Systems - Essential Electric System - Facility failed to maintain the emergency power supply system and conduct required testing. | Level F |
Report Facts
Census: 46
Total Capacity: 60
Deficiencies cited: 14
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Susan Miller | Administrator | Signed the plan of correction and was named as supervising person for multiple corrective actions |
| Staff B | Nursing Assistant | Named in care plan deficiency related to resident leg wraps |
| Staff C | Registered Nurse | Named in care plan deficiency related to weekly body audits and medication regimen review education |
| Staff D | Staff Development Coordinator | Interviewed regarding documentation of urinary output |
| Staff E | Registered Nurse Practitioner | Interviewed regarding weight monitoring and care plan interventions |
| Staff F | Nursing Assistant | Named in annual performance review deficiency |
| Staff G | Nursing Assistant | Named in annual performance review deficiency |
| Staff H | Nursing Assistant | Named in annual performance review deficiency |
| Staff J | Named in employee immunization deficiency | |
| Staff K | Named in employee immunization deficiency | |
| Staff L | Named in employee immunization deficiency | |
| Staff M | Named in employee immunization deficiency | |
| Staff N | Named in employee immunization deficiency | |
| Staff O | Named in employee immunization deficiency |
Inspection Report
Plan of Correction
Deficiencies: 0
May 18, 2023
Visit Reason
An off-site desk audit was conducted to review all previous deficiencies cited on March 6, 2023, and to verify correction based on an acceptable plan of correction and supporting documentation.
Findings
All deficiencies cited in the previous inspection have been corrected, and the facility is in compliance with all regulations surveyed.
Report Facts
Previous deficiencies cited: Deficiencies cited on March 6, 2023
Inspection Report
Renewal
Census: 47
Capacity: 60
Deficiencies: 6
Apr 6, 2023
Visit Reason
A Recertification Survey was conducted at Apple Rehab Clipper Nursing Home from 04/03/2023 through 04/06/2023 to determine compliance with 42 CFR Part 483 requirements for Long Term Care Facilities, including state licensure and emergency preparedness surveys.
Findings
Deficiencies were cited as a result of the survey, including failures in quarterly assessments, physician supervision, medication storage and administration, menu adequacy, and food procurement and safety. The facility provided plans of correction with targeted substantial compliance dates.
Severity Breakdown
SS=E: 2
SS=D: 4
Deficiencies (6)
| Description | Severity |
|---|---|
| Facility failed to assess residents using a quarterly review instrument at least every 3 months for 4 of 6 residents (IDs 1, 18, 22, 39). | SS=E |
| Facility failed to ensure medical care of residents was supervised by a physician for 3 of 5 residents (IDs 1, 27, 55). | SS=E |
| Facility failed to store all drugs and biologicals in locked compartments for 3 residents (IDs 21, 51, 212). | SS=D |
| Facility failed to ensure residents were observed taking medications and that medications were not left at bedside for residents (IDs 21, 51, 212). | SS=D |
| Facility failed to ensure menus were followed and residents received protein with each meal (IDs 4, 12, 35, 57). | SS=D |
| Facility failed to procure, store, and serve food in accordance with professional standards and food safety requirements, including labeling and temperature control. | SS=D |
Report Facts
Census: 47
Total Capacity: 60
Deficiencies cited: 6
Weight loss percentages: 6.47
Weight loss percentages: 7.55
Weight loss percentages: 6.2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Susan Miller | Administrator | Signed the plan of correction on 4/18/23 |
Inspection Report
Follow-Up
Deficiencies: 0
Mar 31, 2022
Visit Reason
A follow up survey to a federal complaint investigation survey was conducted at this facility.
Findings
All former citations were corrected and no new deficient practice was identified.
Inspection Report
Complaint Investigation
Census: 51
Capacity: 55
Deficiencies: 10
Mar 10, 2022
Visit Reason
A Recertification and Complaints Investigation Survey was conducted from 3/7/2022 through 3/10/2022 to determine compliance with 42 CFR Part 483 requirements for Long Term Care Facilities, including a state licensure and emergency preparedness survey.
Findings
The facility was found to be in substandard quality care relative to F 692 with deficiencies cited in areas including immunization and health screening of employees, professional standards of care, bowel movement protocols, pressure ulcer treatment, nutrition and hydration, medication administration, food safety, hospice services, infection control, and quality assurance performance improvement activities.
Complaint Details
This was a complaint investigation survey combined with a recertification survey. Deficiencies were cited as a result of the complaint investigation and survey findings.
Deficiencies (10)
| Description |
|---|
| Facility failed to obtain evidence of immunity for 7 of 10 employees for Tdap vaccine as required by immunization regulations. |
| Facility failed to provide care and services that meet professional standards of quality for 1 resident related to bowel movement medications and TED stockings. |
| Facility failed to provide necessary treatment and services to promote wound healing and prevent new pressure ulcers for 3 of 6 residents reviewed. |
| Facility failed to maintain acceptable nutritional status and follow weight monitoring policy for 9 of 12 residents reviewed. |
| Facility failed to ensure medication error rates were below 5% and failed to ensure medication administration was free of errors for 1 resident. |
| Facility failed to provide special eating equipment and utensils for 2 residents who utilize assistive devices. |
| Facility failed to ensure food safety requirements including proper labeling, storage, and disposal of food items. |
| Facility failed to ensure hospice services met requirements including agreements, care plans, and staff responsibilities. |
| Facility failed to establish and maintain an infection prevention and control program to prevent communicable diseases and infections. |
| Facility failed to maintain and implement an infection control program including hand hygiene and cleaning of blood glucose meters. |
Report Facts
Residents present: 51
Total licensed beds: 55
Employees without Tdap evidence: 7
Residents reviewed for nutrition: 12
Residents with pressure ulcers reviewed: 6
Medication error rate: 7.69
Inspection Report
Life Safety
Deficiencies: 0
Mar 9, 2022
Visit Reason
The annual Federal Life Safety Code survey was conducted by the State Survey Agency pursuant to the National Fire Protection Association 101 Life Safety Code, 2012 Edition.
Findings
No Life Safety Code deficiencies were identified during the survey.
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