Barron Care and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Barron Care and Rehabilitation, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jul 10, 2023

  Based on interview and record review, the facility did not ensure residents received adequate supervision to prevent accidents for 3 of 3 residents (R) reviewed who smoke (R1, R2, and R3). R1 was given smoking materials and exited the building to smoke. Nursing staff did not turn off or remove R1's oxygen before R1 exited the building. R1 received first and second degree burns to the face as a result of attempting to light a cigarette while receiving oxygen therapy via nasal cannula. There was a reasonable likelihood for even more serious harm given the dangers of smoking in an oxygen-enriched environment. […]

• Actual harm, isolatedF686Oct 9, 2024

  Based on observation, interview, and record review, the facility did not provide care consistent with professional standards to prevent development of a pressure injury (PI) for two of three residents (R) reviewed for pressure injuries (R29 and R18.) R29 was admitted to the facility with no skin impairments and developed a stage 3 pressure injury to the coccyx area (tailbone) which remains unhealed, due to lack of comprehensive assessments, lack of timely care plan interventions, and lack of repositioning. […]

• No harm, potential for more than minimal, widespreadF730Jan 7, 2026

  Based on interview and record review, the facility did not complete a performance review of every nurse aide at least every 12 months and provide 12 hours of regular in-service education based on the outcome of for 6 of 6 CNAs reviewed. This has the potential to affect all 47 residents.This is evidenced by:On 01/06/26, a sample of CNAs employed by the facility was selected for review for the completion of annual performance reviews. The facility provided the following information:CNA D has a hire date of 06/10/24. The annual performance review is dated 06/19/25. No documentation of in-service education based on performance review is noted.CNA K has a hire date of 04/24/24. The annual performance review is dated 08/12/25. […]

• No harm, potential for more than minimal, widespreadF947Jan 7, 2026

  Based on interview and record review, the facility did not complete the required annual 12 hours of in-service training for nurse aides for 6 of 6 CNAs reviewed. This has the potential to affect all 47 residents.This is evidenced by:On 01/06/26, a sample of CNAs employed by the facility was selected for review for 12 hours of in-service training. The facility provided the following documentation:CNA D has a hire date of 06/10/24. No documentation of required annual 12 hours of in-service training.CNA K has a hire date of 04/24/24. No documentation of required annual 12 hours of in-service training.CNA L has a hire date of 10/22/21. No documentation of required annual 12 hours of in-service training.CNA M has a hire date of 04/15/24. […]

• No harm, potential for more than minimal, widespreadF880Oct 25, 2023

  Based on observation, interview, and record review, the facility did not maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. This had the potential to affect all 34 residents in the building. The facility's Water Management Plan (WMP) was not based on current standards of practice and did not: - Describe the building's water system using a flow diagram of the system to include an assessment of the facility's water system to identify all locations where Legionella could grow and spread. […]