Autumn Lake Healthcare at Waugh Chapel

In the surveyor’s words

From the most serious findings on record at Autumn Lake Healthcare at Waugh Chapel, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF584Jun 30, 2026

  Based on record reviews and interviews it was determined that the facility failed to consistently maintain a comfortable homelike environment for the residents. This deficient practice was evidenced in 18 of 29 days during the month of June.The findings are:On 06/29/26 at 10:53 am during observation rounds the surveyor observed a total of twelve portable air conditioning units on the nursing units throughout the building.On 06/29/26 at 10:59 am the surveyor spoke with Resident #5 and asked did they have any issues with the temperature of the building. Resident #5 verbalized it was hot a couple of weeks ago for a few days, but it was cool at that time. On 06/29/06 at 11:01 am the surveyor asked Resident #6 were there days when it was hot in the building. […]

• No harm, potential for more than minimal, patternF919May 6, 2026

  Based on observations and interviews with residents and facility staff it was determined that the facility failed to ensure the resident call bell system was functioning properly. This was found to be evident in 4 Resident's (#68, #125, #106, #74) rooms in 3 of 3 units observed for call light function and response. Findings include: 1. An initial tour of the facility was conducted on 5/3/26 at approximately 10:50 AM on the 100 hallway. During an interview with Resident # 68 the resident stated that s/he wanted to express concerns regarding call response times of staff. The resident stated that it takes up to three hours to get assistance to go to the bathroom. The resident stated that there are times that the call light does not work. […]

• No harm, potential for more than minimal, patternF812Mar 17, 2025

  Based on observation and interview with facility staff, it was determined that the facility failed to maintain the safety of the food items to prevent foodborne illness. This was evident for two nourishment room refrigerators out of two nourishment room refrigerators audited during the recertification/complaint survey. The findings include: During the surveyor's tour of the facility on 03/13/25 at 12:10 PM, the surveyor observed a large zip-lock bag with cooked food items dated 03/08/25 and an uncooked cauliflower, brown to black in color in a plastic bag dated 03/08 in the refrigerator, located in the nourishment room, close to the 400-unit Nurses' station. […]

• No harm, potential for more than minimal, isolatedF641Jun 30, 2026

  Based on record review and interview it was determined that the facility staff failed to accurately code a resident's MDS assessment. This deficient practice was evidenced in 1 (#2) of 3 MDS assessments reviewed during the complaint survey.The Minimum Data Set (MDS) is a federally mandated standardized clinical assessment tool used in Medicare and Medicaid-certified nursing homes to evaluate the health, functional capacity, and care needs of residents.The findings include:On 06/30/26 at 12:05 pm a review of Resident #2 medication administration record (MAR) for June 2026 revealed the resident was ordered and receiving Normal Saline 10 ml intravenous (IV) every shift from 06/02/26 until the order was discontinued on 06/15/26. […]

• No harm, potential for more than minimal, isolatedF550May 6, 2026

  Based on observation and interview, it was determined that the facility failed to maintain resident dignity by leaving a resident's urinary catheter tubing uncovered and in public view. This was evident for 1 (resident # 35) out of 1 resident observed with a urinary catheter during the survey.The findings include:During observation rounds on 05/03/2026 at approximately 10:47 AM, Surveyor observed Resident #35 sitting in a geriatric chair in the facility dining room with a urinary catheter in place. The catheter tubing was uncovered and exposed in public view. […]