Arbor Lake Nursing & Rehabilitation, LLC

In the surveyor’s words

From the most serious findings on record at Arbor Lake Nursing & Rehabilitation, LLC, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Apr 15, 2025

  43791 Based on observations, interviews, and record reviews the facility failed to ensure the resident environment remains as free of accident hazards as is possible for 1 of 3 residents (Resident #1) reviewed for accidents. The facility failed to ensure Resident #1 was free from accidents/hazards on 03/16/25 when she was shocked after plugging in her phone charger to the wall socket, that resulted in burns to her fingers and hand. An IJ was identified on 04/14/25. The IJ template was provided to the facility on [DATE] at 4:03 PM. […]

• Actual harm, isolatedF600Jul 25, 2025

  Based on observation, interview, and record review, the facility failed to ensure residents had the right to be free from abuse for 1 of 6 residents (Resident #33) reviewed for abuse. The facility failed to ensure residents were free resident-to-resident abuse when Resident #33 entered Resident #21's room, and Resident #21 pushed Resident #33 down. Resident #33 sustained abrasions on his nose and right knee. The failure placed residents at risk for abuse. Findings included:Record review of Resident #33's Quarterly MDS, dated [DATE], reflected Resident #33 was a [AGE] year-old male, who admitted to the facility on [DATE]. […]

• Actual harm, isolatedF744Jul 25, 2025

  Based on observation, interview, and record review, the facility failed to ensure that a resident who displays or was diagnosed with dementia, receives the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being for 1 of 4 residents (Resident #33) reviewed for dementia services. The facility failed to ensure Resident #33 was provided with treatment and services to address his wandering behaviors related to his diagnosis of dementia which resulted in the resident entering Resident #21's room and being pushed by Resident #1. Upon being pushed, Resident #33's face/head bumped Resident #21's dresser, and Resident #33 sustained abrasions on his nose and right knee. […]

• No harm, potential for more than minimal, patternF925May 19, 2026

  Based on observation, interview and record review, the facility failed to maintain an effective pest control program for 1 of 1 kitchen to keep it free of flies. The facility failed to ensure the kitchen was free of flies on 05/19/26. This failure could affect residents who eat from the kitchen placing them at risk for the potential spread of infection and decreased quality of life.Findings included: Observation on 05/19/26 at 10:45 AM of the facility's kitchen revealed there were 7 flies, 5 of the flies were on a cord of the food processor that was plugged into the outlet, 1 fly was on the outlet, and another fly was observed on the leg of the prep table while 3 staff members prepared lunch. […]

• No harm, potential for more than minimal, patternF567Sep 8, 2025

  Based on observations, interviews and record reviews, the facility failed to act as a fiduciary of the residents' funds and hold, safeguard, manage and account for the personal funds of the resident deposited with the facility for nine (Residents #1, #2, #3, #4, #5, #6, #7, #8 and #9) of nine residents reviewed for resident trust accounts. The facility did not monitor resident trust fund account balances to ensure funds did not exceed Medicaid resource limits. The facility allowed Residents #1, # 2, #3, #4, #5, #6, #7, #8 and #9 trust funds to remain over $3,000, which placed them at risk of losing their Medicaid eligibility. […]