Avalon Care Center at Northpointe

In the surveyor’s words

From the most serious findings on record at Avalon Care Center at Northpointe, in the surveyor’s own words.

• Actual harm, isolatedF692Feb 7, 2025

  Based on observation, interview, and record review, the facility failed to ensure acceptable parameters of nutrition were maintained for 2 of 2 sampled residents (Residents 4 and 14) reviewed for nutrition. Resident 4 experienced harm when they had a significant weight loss of 7.9% in approximately three months and 14.29% in six months. Resident 14 experienced harm when they had a significant weight loss of 8.51% in one month and their weight loss was not reported to the dietician. […]

• Actual harm, isolatedF689Oct 2, 2024

  Based on interview and record review, the facility failed to provide supervision for 1 of 3 sampled residents (Resident 1) reviewed for accidents. Resident 1 was harmed when they wandered unassisted in to the hall, intercepted fall (occurs when the resident would have fallen if they had not caught themself or had not been intercepted by another person - this is still considered a fall) and sustained a fractured humerus (the upper arm bone). This failure put residents at risk for injuries and decreased quality of life. Findings included . A review of the 08/22/2024 admission assessment documented Resident 1 had diagnoses including dementia and anxiety. […]

• No harm, potential for more than minimal, widespreadF812Feb 7, 2025

  Based on observation, interview, and record review the facility failed to store, discard and distribute food, and monitor temperatures of foods being served in accordance with professional standards for food safety for 1 of 1 facility kitchens, reviewed. This failure placed residents at risk for food borne illness and diminished quality of life. Findings included . Review of the U.S. Food and Drug Administration (FDA) Food Code 2022 revised [DATE], showed that food must be labeled with the date the food was prepared, the package opened, and the date the food must be discarded as directed by the food manufacturer's use-by-date. The U.S. FDA Food Code 2022 also showed that there was an increased risk of contamination when food was held, cooled and reheated at improper temperatures. […]

• No harm, potential for more than minimal, patternF607Jun 23, 2026

  Based on interview and record review, the facility failed to implement their Abuse and Neglect Prohibition Policies to include not reporting allegations of abuse to facility administration and the State Agency (SA) within the required timeframe, and completing thorough investigations, for 5 of 7 sampled residents (Resident 5, 38, 69, 117, and 131), reviewed for abuse/neglect. This failure placed the residents at risk for unidentified abuse/neglect. Findings included .Review of the facility's policies titled Preventing and Prohibiting Abuse and Abuse Reporting and Responsibilities of Covered Individuals, revised 09/13/2022, showed staff were to report alleged abuse to the facility administrator and SA immediately, but not later than two hours after the allegation was made if abuse was… […]

• No harm, potential for more than minimal, patternF584May 28, 2026

  Based on observation and interview, the facility failed to maintain a clean, comfortable, and homelike environment for 1 of 3 units (Unit 1 - North Unit), observed for environment. This failure resulted in residents being unable to have a clear view to the outside through several windows. Findings included.During an interview on 05/19/2026 at 1:05 PM, the resident council stated the facility did not clean the windows, they were too dirty and unable to see outside.During observation on 05/21/2026 at 9:12 AM, on Unit 1 - North Unit, both windows in room [ROOM NUMBER] had a white film, similar to hard water residue (chalk, white mineral spots), on the outside of the windows which made the whole window blurry to look out of. […]