Inspection Reports for
The Valley Rehabilitation and Healthcare Center

The complaint investigation was triggered by an incident on 9/15/25 where Resident #1 was injured during transport when the vehicle stopped abruptly and the resident fell out of her wheelchair. The incident was substantiated with findings of improper seatbelt securement and incompatible seatbelt components.

The facility failed to ensure Resident #1 was safely secured during transport, leading to a fall and femur fracture requiring surgery. The investigation found incompatible seatbelt components were used, and the transport driver was suspended. The facility implemented corrective actions including retraining drivers, removing incompatible seatbelts, and instituting daily vehicle safety inspections.

The complaint investigation substantiated that the facility did not provide medical records timely to Resident #1's representative and failed to revise fall care plans appropriately for Residents #1 and #3 after multiple falls.

The facility failed to provide requested medical records timely to Resident #1's representative due to incorrect contact information and delays in sending records. Additionally, the facility failed to revise and update fall care plans with new interventions after multiple falls for Residents #1 and #3, despite documented falls and injuries.

The facility failed to ensure proper medication storage and labeling, safe food handling and temperature control, effective infection prevention and control practices, and sanitary cleaning of residents' rooms and personal care items. Multiple observations and staff interviews revealed deficiencies in these areas with minimal harm or potential for actual harm to residents.

The facility was found deficient in multiple areas including improper storage and labeling of medications, unsafe food handling and temperature control, inadequate infection prevention and control practices, unsanitary housekeeping procedures, unlabeled personal care items, and improper maintenance of urinary catheter drainage bags.

The complaint investigation focused on Resident #24's lack of timely assistance with ADLs and Resident #41's inappropriate dementia care, including wandering behaviors, intrusive actions toward other residents, and psychosocial harm after placement in the secure unit. Multiple resident complaints about Resident #41's behaviors were documented, and the facility failed to implement adequate person-centered interventions or supervision.

The facility failed to ensure Resident #24 received timely assistance with bathing, grooming, oral care, and clean clothing. The facility also failed to provide appropriate treatment and services to Resident #41 with dementia, resulting in psychosocial harm after placement in the secure unit. Additionally, medication storage refrigerator temperatures were found to be below recommended levels.

The facility failed to ensure residents were not required to waive liability for loss of personal property, failed to provide adequate person-centered activities for residents with cognitive impairments, failed to properly store vaccines in the medication refrigerator, and failed to maintain proper cleaning, sanitizing, and date marking in the kitchen.