Inspection Report
Census: 72
Capacity: 115
Deficiencies: 0
Aug 18, 2025
Visit Reason
The inspection was conducted as a partial, unannounced visit due to an incident at the facility.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Total Daily Staff: 111
Waking Staff: 83
Residents Served: 72
License Capacity: 115
Current Hospice Residents: 4
Residents Age 60 or Older: 72
Residents with Mental Illness: 1
Residents with Mobility Need: 39
Inspection Report
Census: 79
Capacity: 115
Deficiencies: 0
Jul 14, 2025
Visit Reason
The inspection was conducted as a partial, unannounced visit due to an incident at the facility.
Findings
No regulatory citations or deficiencies were identified during this inspection.
Report Facts
Residents Served: 79
License Capacity: 115
Current Hospice Residents: 5
Residents Age 60 or Older: 79
Residents with Mental Illness: 1
Residents with Mobility Need: 44
Inspection Report
Renewal
Census: 78
Capacity: 115
Deficiencies: 9
Jun 10, 2025
Visit Reason
The inspection was conducted as a renewal inspection of the facility's license, with an unannounced full inspection on 06/10/2025 and an exit conference on 06/11/2025.
Findings
The inspection identified multiple deficiencies related to resident record confidentiality, staff training, furniture and equipment safety, exterior hazards, lighting, medication management including labeling and storage, and medication record accuracy. All deficiencies had accepted plans of correction with proposed completion dates and were determined to be fully implemented by the follow-up.
Deficiencies (9)
| Description |
|---|
| Resident records were found unsecured in an unlocked bin on a medication cart accessible to unauthorized persons. |
| Direct care staff person provided unsupervised assisted living services without completing required training and competency test. |
| Bed enabler on resident's bed was improperly installed and had an uncovered opening posing a hazard. |
| Exterior fountain water feature posed a drowning risk due to accessible water without adequate barriers. |
| Resident in room #119 did not have access to an operable bedside light source. |
| Expired medication (Tramadol) was found in the medication cart beyond its use date. |
| Prescription medication labels did not match physician orders in dosage or administration instructions for multiple residents. |
| Blood glucose readings were incorrectly recorded on residents' medication administration records. |
| Medication administration records did not include proper dosage form instructions for certain medications. |
Report Facts
Total Daily Staff: 125
Waking Staff: 94
License Capacity: 115
Residents Served: 78
Current Hospice Residents: 3
Residents with Mobility Need: 47
Residents 60 Years or Older: 78
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Inspection Report
Follow-Up
Census: 76
Capacity: 115
Deficiencies: 2
Feb 7, 2025
Visit Reason
The visit was a follow-up inspection to review the submitted plan of correction related to a previous incident involving resident abuse and supervision of staff.
Findings
The submitted plan of correction was found to be fully implemented. The facility was required to maintain continued compliance with regulations regarding immediate development and submission of supervision plans or suspension of staff involved in abuse allegations.
Deficiencies (2)
| Description |
|---|
| Failure to immediately develop and implement a plan of supervision or suspend the staff person involved in an alleged resident abuse incident. |
| Failure to immediately submit to the Department a plan of supervision or notice of suspension of the affected staff person involved in an alleged resident abuse incident. |
Report Facts
Residents Served: 76
License Capacity: 115
Current Hospice Residents: 6
Residents Age 60 or Older: 76
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 35
Residents with Physical Disability: 1
Inspection Report
Census: 82
Capacity: 115
Deficiencies: 0
Dec 13, 2024
Visit Reason
The inspection was conducted as a partial, unannounced visit due to an incident.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Residents Served: 82
License Capacity: 115
Current Hospice Residents: 9
Residents Age 60 or Older: 82
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 39
Inspection Report
Follow-Up
Census: 82
Capacity: 115
Deficiencies: 3
Nov 15, 2024
Visit Reason
The inspection was conducted as a partial, unannounced follow-up visit triggered by an incident to verify the implementation of a previously submitted plan of correction.
Findings
The facility was found to have fully implemented the submitted plan of correction related to delayed reporting and supervision of a resident abuse allegation. The report details corrective actions including staff training, audits, and reviews to ensure immediate reporting and supervision compliance.
Complaint Details
The visit was related to a complaint/incident involving an allegation of physical abuse by a staff person against a resident. The allegation was initially reported late to the appropriate authorities, and the staff person involved continued to work unsupervised for several hours after the allegation was made. The complaint was substantiated with repeat violations noted.
Deficiencies (3)
| Description |
|---|
| Failure to immediately report suspected abuse of a resident to the local Area Agency on Aging. |
| Failure to immediately develop and implement a plan of supervision or suspend the staff person involved in the alleged abuse incident. |
| Failure to report the incident or condition to the Department’s assisted living residence office or complaint hotline within 24 hours. |
Report Facts
License Capacity: 115
Residents Served: 82
Current Hospice Residents: 7
Residents with Mobility Need: 35
Date of Inspection: Nov 15, 2024
Plan of Correction Submission Dates: 3
Inspection Report
Follow-Up
Census: 84
Capacity: 115
Deficiencies: 1
Jun 10, 2024
Visit Reason
The inspection visit on 06/10/2024 was a follow-up to review the submitted plan of correction related to a complaint and incident.
Findings
The submitted plan of correction was determined to be fully implemented as of the follow-up inspection. The facility had self-reported a medication error involving administration of the wrong insulin type and took corrective actions including staff education and ongoing audits.
Complaint Details
The visit was complaint-related and involved a medication error incident reported by the facility. The resident was administered the wrong insulin type and dosage on 05/18/2024, resulting in hospital follow-up. The issue was addressed with staff education and monitoring.
Deficiencies (1)
| Description |
|---|
| Failure to follow prescriber's orders resulting in administration of the wrong insulin type and dosage. |
Report Facts
License Capacity: 115
Residents Served: 84
Current Hospice Residents: 3
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 11
Total Daily Staff: 95
Waking Staff: 71
Medication Error Date: May 18, 2024
Medication Pass Competencies: 4
Plan of Correction Completion Date: Jul 19, 2024
Inspection Report
Renewal
Census: 80
Capacity: 115
Deficiencies: 4
Dec 11, 2023
Visit Reason
The inspection was conducted as a renewal inspection of the facility to review compliance and verify the implementation of the submitted plan of correction.
Findings
The submitted plan of correction was determined to be fully implemented. Deficiencies were identified related to fire drill record keeping, medication management including current medications, medication labeling, and storage procedures, with directed plans of correction and ongoing audits to ensure compliance.
Deficiencies (4)
| Description |
|---|
| Fire drill records did not include evacuation time in minutes and seconds for numerous fire drills. |
| Resident #1 had discontinued medication still present in the residence. |
| Resident #2's medication label had incorrect dosage instructions compared to the medication administration record. |
| Resident #3's glucometer was not set to the correct time, leading to incorrect documentation of blood glucose readings. |
Report Facts
License Capacity: 115
Residents Served: 80
Total Daily Staff: 123
Waking Staff: 92
Current Residents in Hospice: 5
Residents Age 60 or Older: 80
Residents with Mental Illness: 1
Residents with Intellectual Disability: 1
Residents with Mobility Need: 43
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Wesley Robinson | Administrator | Named as facility administrator. |
| Director of Resident Care | Named in relation to medication error findings and corrective actions. |
Inspection Report
Census: 79
Capacity: 115
Deficiencies: 0
Aug 31, 2023
Visit Reason
The inspection was conducted as a partial, unannounced licensing inspection due to an incident at the facility on 08/31/2023.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
License Capacity: 115
Residents Served: 79
Current Hospice Residents: 5
Residents Age 60 or Older: 79
Residents Diagnosed with Mental Illness: 2
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 4
Residents with Physical Disability: 0
Resident Support Staff: 0
Total Daily Staff: 83
Waking Staff: 62
Inspection Report
Complaint Investigation
Census: 82
Capacity: 115
Deficiencies: 0
Jul 7, 2023
Visit Reason
The inspection was conducted as a complaint investigation at Cumberland Crossing Manor on 07/07/2023.
Findings
No regulatory citations or deficiencies were identified during this unannounced partial inspection.
Complaint Details
The inspection was triggered by a complaint; however, no deficiencies or citations were found.
Report Facts
Residents Served: 82
License Capacity: 115
Current Hospice Residents: 4
Residents Age 60 or Older: 82
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 43
Inspection Report
Complaint Investigation
Census: 78
Capacity: 115
Deficiencies: 5
Jan 26, 2023
Visit Reason
The inspection was conducted as a complaint investigation and incident review related to allegations of resident abuse and neglect at Cumberland Crossing Manor.
Findings
The investigation found that staff person A sprayed cold water in a resident's face causing injury and distress, failed to immediately report the abuse, and continued to work unsupervised after the incident. Additional incidents of intimidation and abuse by staff person A were reported. The facility implemented education, audits, and corrective actions including suspension and termination of staff person A. Deficiencies were noted in abuse reporting, supervision, incident reporting, and resident assessment documentation.
Complaint Details
The complaint involved allegations that staff person A sprayed cold water in resident #1's face causing bleeding and distress, failed to report the abuse immediately, and continued to work unsupervised. Resident #1 also reported other incidents of intimidation and physical abuse by staff person A. Protective Services investigation found no substantiation initially, but further details emerged during licensing investigation. Staff person A was terminated. The facility implemented education and auditing to prevent recurrence.
Deficiencies (5)
| Description |
|---|
| Failure to immediately report suspected resident abuse to the Local Area Agency on Aging. |
| Failure to immediately suspend or implement a supervision plan for staff person involved in alleged abuse. |
| Failure to report the incident to the Department’s assisted living residence office within 24 hours. |
| Resident subjected to neglect, intimidation, and physical/verbal abuse by staff person A. |
| Written initial assessment did not include medical condition, care services, or agency information for resident with wounds/ulcers. |
Report Facts
License Capacity: 115
Residents Served: 78
Current Hospice Residents: 4
Residents with Mobility Need: 40
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Inspection Report
Renewal
Census: 75
Capacity: 115
Deficiencies: 6
May 2, 2022
Visit Reason
The inspection was conducted as a renewal inspection of the facility license for Cumberland Crossing Manor.
Findings
The inspection identified several deficiencies including unlocked resident face sheets and medications, outdated fire safety inspection and fire drill, incomplete fire drill records, prolonged evacuation times during fire drills, and a medication administration error due to unavailable medication. Plans of correction were submitted and implemented for all deficiencies.
Deficiencies (6)
| Description |
|---|
| Numerous resident face sheets were unlocked, unattended, and accessible at the 2nd floor nurses station. |
| The most recent fire safety inspection and supervised fire drill conducted by a fire safety expert was completed on 10/29/20, not within the required annual timeframe. |
| The fire drill record for the drill conducted on 1/31/22 did not include the number of staff persons who participated and incorrectly recorded resident evacuation numbers. |
| The residence does not have a maximum safe evacuation time specified in writing by a fire safety expert within the past year, and evacuation times during fire drills exceeded 2 minutes 30 seconds, with times ranging from 6 minutes 1 second to 10 minutes 19 seconds. |
| Numerous over-the-counter topical medications were unlocked, unattended, and accessible in a filing cabinet at the 2nd floor nurses station. |
| Resident #6 was prescribed Lorazepam 0.5mg tablets but did not receive the medication from 4/21/22 through 5/3/22 because the medication was not available in the residence. |
Report Facts
License Capacity: 115
Residents Served: 75
Current Hospice Residents: 3
Evacuation Time: 361
Evacuation Time: 619
Evacuation Time: 447
Evacuation Time: 512
Residents Evacuated: 72
Residents Refused Evacuation: 3
Inspection Report
Complaint Investigation
Census: 82
Capacity: 115
Deficiencies: 0
Aug 11, 2021
Visit Reason
The inspection was conducted as a complaint investigation during an unannounced partial licensing inspection.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Complaint Details
The inspection was complaint-related, but no deficiencies or substantiated issues were found.
Report Facts
Residents Served: 82
License Capacity: 115
Hospice Residents: 10
Residents 60 Years or Older: 82
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 42
Residents with Physical Disability: 1
Notice
Capacity: 115
Deficiencies: 0
May 17, 2021
Visit Reason
The document serves as a certificate of compliance and a renewal notice for the Assisted Living Home Cumberland Crossing Manor, confirming the facility's license renewal and advising that an annual inspection will be conducted within the next twelve months.
Findings
No inspection findings are reported in this document; it confirms issuance of a regular license following the renewal application and outlines the requirement for an annual inspection.
Report Facts
Maximum capacity: 115
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jamie L. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal notice letter |
Inspection Report
Renewal
Census: 82
Capacity: 115
Deficiencies: 3
Mar 30, 2021
Visit Reason
The inspection was conducted as a renewal visit to review compliance and verify the submitted plan of correction for Cumberland Crossing Manor.
Findings
The inspection found sanitary condition issues including a pervasive urine odor in a resident's room, lack of operable bedside lighting for a resident, and a delayed annual resident assessment. Plans of correction were accepted and implemented with audits and staff education planned.
Deficiencies (3)
| Description |
|---|
| Resident #1's room had a pervasive and pungent odor of urine. |
| Resident #2 did not have access to a source of light that can be turned on at bedside. |
| Resident #3's annual assessment was delayed; previous assessment was completed on 3/2/2020 but signed on 3/30/2021. |
Report Facts
Residents Served: 82
License Capacity: 115
Total Daily Staff: 112
Waking Staff: 84
Current Residents in Hospice: 3
Residents Age 60 or Older: 82
Residents with Mobility Need: 30
Residents with Physical Disability: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dan Grant | COO | Mentioned as facility administrator contact |
| Jon Kimberland | Author of the inspection report letter | |
| Director of Resident Care | Director of Resident Care | Provided ADL staff education and signed annual assessment |
| Resident Support Coordinator | Resident Support Coordinator | Involved in resident assessment process |
| Maintenance Director | Maintenance Director | Installed bedside lighting and reviewed regulations with staff |
| Lead Housekeeper | Lead Housekeeper | Responsible for auditing new residents' rooms for compliance |
| Administrator | Administrator | Provided education and oversight of audits and compliance |
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