Inspection Report Summary
The most recent inspection on June 26, 2025, found the facility to be in substantial compliance with regulatory requirements and identified no deficiencies. Earlier inspections also showed a consistent pattern of compliance without noted issues or citations. There were no complaint investigations reported in the available records. Enforcement actions such as fines or license suspensions were not listed in the available reports. This indicates a stable compliance trend with no recent or past concerns documented.
Deficiencies (last 4 years)
Deficiencies are regulatory violations found during state inspections.
Deficiencies per year
Inspection Report
Annual InspectionInspection Report
RenewalInspection Report
Routine| Name | Title | Context |
|---|---|---|
| Assistant Director of Nursing | Assistant Director of Nursing (ADON) | Interviewed regarding awareness and response to call system failures. |
| Maintenance Director | Maintenance Director | Interviewed about responsibility and actions taken to repair call system. |
| Former Maintenance Director | Former Maintenance Director | Interviewed about historical issues with call system and supply difficulties. |
| State Registered Nursing Assistant #1 | State Registered Nursing Assistant (SRNA) | Interviewed about observations of call light functionality. |
| Director of Nursing | Director of Nursing (DON) | Interviewed about awareness and expectations regarding call system functionality. |
| Administrator | Administrator | Interviewed about importance of call lights and expectations for maintenance response. |
Inspection Report
Annual InspectionInspection Report
Annual Inspection| Name | Title | Context |
|---|---|---|
| CNA #1 | Certified Nurse Aide | Mentioned in relation to feeding assistance deficiency for Resident #44 |
| CNA #3 | Certified Nurse Aide | Mentioned in relation to feeding assistance and resident rights training |
| LPN #1 | Licensed Practical Nurse | Mentioned in relation to feeding Resident #44 |
| LPN #2 | Licensed Practical Nurse | Mentioned in relation to feeding Resident #23 |
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding feeding assistance, care planning, and psychotropic medication use |
| MDS Coordinator | MDS Coordinator | Interviewed regarding assessment coding and care plan responsibilities |
| Certified Nurse Assistant #4 | Certified Nurse Aide | Mentioned in relation to continence management documentation |
| Registered Nurse #2 | Registered Nurse | Mentioned in relation to continence management and admission procedures |
| Registered Nurse #1 | Registered Nurse | Mentioned in relation to continence management and CNA supervision |
| Assistant Director of Nursing | Assistant Director of Nursing (ADON) | Mentioned in relation to continence management oversight |
| Dementia Program Director | Dementia Program Director (DPD) | Interviewed regarding dementia care plan development |
| Resident #43's attending Physician | Physician/Medical Director | Interviewed regarding psychotropic medication use for Resident #43 |
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