Deficiencies per Year
4
3
2
1
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Inspection Report
Annual Inspection
Deficiencies: 0
Apr 17, 2025
Visit Reason
An Annual Recertification Survey was conducted from April 14, 2025 to April 17, 2025.
Findings
The facility was found to be in substantial compliance.
Inspection Report
Annual Inspection
Deficiencies: 0
Jun 6, 2024
Visit Reason
The inspection was conducted as an annual recertification survey and included an investigation of a facility reported incident #121097-I.
Findings
The facility was found to be in substantial compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities. The reported incident #121097-I was not substantiated.
Complaint Details
Facility reported incident #121097-I was investigated and found not substantiated.
Inspection Report
Complaint Investigation
Deficiencies: 0
Jan 31, 2024
Visit Reason
An investigation of Complaints #114900-C, #117622-C, #117624-C and Facility Self-Reported Incidents #114899-I and #114963-I was conducted from January 25, 2024 to January 31, 2024.
Findings
The facility was found in substantial compliance at the time of the investigations.
Complaint Details
Investigation involved multiple complaints and self-reported incidents; facility found in substantial compliance.
Inspection Report
Plan of Correction
Deficiencies: 0
Sep 2, 2023
Visit Reason
The document serves as a statement of deficiencies and plan of correction for the facility, indicating acceptance of a credible allegation of compliance and plan of correction.
Findings
The facility was found to be in compliance based on acceptance of the credible allegation of compliance and plan of correction, with certification effective August 13, 2023.
Inspection Report
Annual Inspection
Census: 54
Deficiencies: 1
Jul 13, 2023
Visit Reason
The inspection was conducted as a Recertification Survey and investigation of a Facility Self-Reported Incident #113329-I from July 10 to July 13, 2023.
Findings
The facility failed to implement care plan interventions to prevent falls for a resident at risk, resulting in a substantiated incident involving a fall with major injury. The facility did not adequately monitor and intervene to prevent falls, violating federal regulations.
Complaint Details
Facility Self-Reported Incident #113329-I was substantiated.
Severity Breakdown
Level D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to implement care plan interventions based on root cause analysis to prevent falls for a resident at risk, resulting in a fall with major injury. | Level D |
Report Facts
Resident census: 54
Incident dates: Incident investigation period from July 10, 2023 to July 13, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Morgan Vander Molen | Human Resources Specialist | Signed the statement of deficiencies and plan of correction |
| Staff C | Registered Nurse (RN) | Observed resident after fall and reported findings |
| Staff E | Certified Medication Aide (CMA) | Discovered resident on floor after fall |
| Staff F | Certified Medication Aide (CMA) | Discovered resident on floor after fall |
| Staff D | Licensed Practical Nurse (LPN) | Reported on resident behavior prior to fall |
| Staff G | Care Plan Coordinator | Discussed fall assessment and interventions |
| Director of Nursing (DON) | Evaluated resident and commented on fall circumstances |
Inspection Report
Complaint Investigation
Census: 58
Deficiencies: 0
Apr 11, 2023
Visit Reason
A COVID-19 Focused Infection Control Survey and an investigation of Complaint #102077-C and a Facility Self-Reported Incident #109389-I were conducted by the Department of Inspections and Appeals from April 11, 2023 to April 13, 2023.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19 and was also found to be in overall substantial compliance.
Complaint Details
Investigation of Complaint #102077-C and Facility Self-Reported Incident #109389-I was conducted; facility found in substantial compliance.
Report Facts
Total Residents: 58
Inspection Report
Annual Inspection
Census: 40
Deficiencies: 2
Oct 28, 2021
Visit Reason
The inspection was conducted as the facility's annual health survey to assess compliance with federal and state regulations.
Findings
The facility was found deficient in providing a bed hold notice upon hospital transfer for 1 of 2 residents reviewed, and failed to implement interventions to prevent pressure ulcers for 1 of 3 residents reviewed. The complaint #95259-C was not substantiated.
Complaint Details
Complaint #95259-C was investigated and found not substantiated.
Deficiencies (2)
| Description |
|---|
| Failure to provide a bed hold notice upon hospital transfer for 1 of 2 residents. |
| Failure to implement interventions to prevent pressure ulcers for 1 of 3 residents reviewed. |
Report Facts
Census: 40
Complaint number: 95259
Incident number: 96910
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Interviewed regarding bed hold policy and pressure ulcer prevention. |
| Administrator | Administrator | Interviewed regarding bed hold policy and facility practices. |
| Staff A | Registered Nurse | Observed providing care related to pressure ulcer prevention. |
| Staff B | Interviewed regarding discovery of pressure ulcer. |
Inspection Report
Annual Inspection
Deficiencies: 0
Aug 27, 2020
Visit Reason
The inspection was conducted as a recertification and annual survey of the facility to assess compliance with federal regulations.
Findings
The facility was found to be in substantial compliance at the time of the recertification and survey conducted from August 24 to 27, 2020.
Inspection Report
Routine
Census: 42
Deficiencies: 0
Jun 17, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Department of Inspections and Appeals to assess compliance with CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with CMS and CDC recommended practices to prepare for COVID-19.
Loading inspection reports...
