Inspection Report Summary
The most recent inspection on April 17, 2025 found the facility to be in substantial compliance with no deficiencies noted. Earlier inspections showed a mixed record, with some deficiencies related primarily to resident care, including fall prevention and pressure ulcer interventions. A substantiated incident in July 2023 involved failure to implement care plan interventions to prevent a fall resulting in major injury. Complaint investigations were generally unsubstantiated or found the facility in substantial compliance, with no fines or enforcement actions listed in the available reports. The inspection history suggests improvement over time, with recent surveys showing compliance after earlier issues.
Deficiencies (last 5 years)
Deficiencies are regulatory violations found during state inspections.
Deficiencies per year
Census
Based on a July 2023 inspection.
Census over time
Inspection Report
Annual InspectionInspection Report
Annual InspectionInspection Report
Complaint InvestigationInspection Report
Plan of CorrectionInspection Report
Annual Inspection| 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 InvestigationInspection Report
Annual Inspection| 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 InspectionInspection Report
RoutineReport
Report
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