Inspection Reports for
Creekside at the Springs

The complaint investigation found that Resident #62 was unable to reach the call light, which was wrapped around the bedrail, and experienced pain and discomfort without timely assistance. Staff acknowledged the resident moaned and cried out frequently and that the call light should have been within reach but was not. The resident required total assistance and was dependent on two staff members for transfers.

The facility failed to keep the call light within reach of Resident #62, who was dependent on staff for assistance, resulting in delayed help and the resident experiencing pain and discomfort. Staff interviews and observations confirmed the resident was unable to reach the call light and did not receive timely assistance despite calling for help.

The complaint investigation found that Resident #62 was unable to reach the call light and experienced delayed assistance despite repeated calls for help. Staff acknowledged the resident's frequent moaning and crying and confirmed the resident required total assistance and was dependent on two staff members for transfers.

The facility failed to keep the call light within reach of Resident #62, who was dependent on staff for assistance, resulting in delayed help despite the resident's repeated requests and visible distress. Staff interviews and observations confirmed the resident's inability to reach the call light and delayed response to their needs.

The complaint investigation revealed substantiated deficiencies including unsafe environmental conditions, failure to obtain and act on lab results causing actual harm and death to Resident #70, and inadequate food temperature management leading to resident dissatisfaction.

The facility failed to maintain a homelike environment with cluttered and unsafe electrical wiring and persistent strong urine odors in resident rooms. The facility also failed to timely obtain and act on lab results for a resident, resulting in delayed treatment, hospitalization, and death. Additionally, meals were served at temperatures below acceptable levels, leading to resident dissatisfaction.

The complaint investigation included issues of resident dignity, environmental safety, failure to follow physician orders and lab result monitoring, pressure ulcer prevention, medication management, food safety and preparation, and kitchen sanitation. The investigation found substantiated deficiencies including immediate jeopardy related to failure to obtain lab results and provide timely treatment resulting in resident hospitalization and death.

The facility was found deficient in multiple areas including failure to ensure residents' dignity and hygiene after meals, failure to maintain a safe and homelike environment with odor control, failure to provide timely lab result follow-up and appropriate treatment resulting in hospitalization and death, failure to provide pressure relieving devices, failure to remove expired medications, failure to serve meals at proper temperatures and correct food consistencies, and failure to maintain proper kitchen hygiene and food safety practices.

The facility was found deficient in ensuring privacy during enteral bolus tube feedings for one resident, proper labeling and timing of enteral feeding bags for two residents, and enforcing hairnet use among kitchen staff. These deficiencies were associated with minimal harm or potential for harm affecting a few to some residents.

The facility failed to ensure the Dietary Manager was properly qualified and trained, sufficient competent staff were employed in the kitchen, food was stored and labeled properly, pureed diets were prepared according to recipes and with appropriate consistency, food temperatures were maintained correctly, and immunization records were properly tracked and documented.