Bridgeview Post Acute

In the surveyor’s words

From the most serious findings on record at Bridgeview Post Acute, in the surveyor’s own words.

• Actual harm, isolatedF600Jun 9, 2026

  Based on observation, interviews, and record review, the facility failed to protect one of three sampled residents (Resident 1) from neglect when nursing staff failed to recognize and appropriately respond to slurred speech, facial drooping, and right sided arm weakness, which represented of a significant change in condition. The facility failed to ensure timely assessment, provider notification (the physician), and medical intervention.This failure resulted in delayed recognition and treatment of Resident 1's brain bleed, contributing to a permanent and preventable decline in functional abilities, including decreased use and strength of the right arm and loss of independence in performing personal tasks.During a review of the facility's policy and procedure (P&P) titled, Change in a… […]

• Actual harm, isolatedF689Oct 15, 2025

  Based on observation, interview, and record review, the facility failed to ensure a plan of care for safety and supervision for one of three sampled residents (Resident 4), when Restorative Nursing Assistant (RNA) H left Resident 4 alone outside on a patio for 30 minutes, where Resident 4 fell and sustained a subdural hematoma (bleeding between the brain and its lining). This deficient practice resulted in Resident 4 experiencing a major head injury, emergency care at hospital, and a significant decline in their quality of life. Resident 4 was transferred to the hospital on [DATE] after he fell. Resident 4 returned to the facility on [DATE], with Hospice services (specialized end of life care). […]

• Actual harm, isolatedF695Mar 7, 2024

  Based on interview and record review the facility failed to ensure one of four sampled residents (Resident 1) received respiratory care when a physician ordered Bilevel Positive Airway Pressure (BiPAP-a device that helps breathing) was not implemented for 14 days. This resulted in an emergent transfer to hospital for treatment for severe respiratory failure (not enough oxygen) for five days. Findings: A review of Resident 1 ' s hospital discharge summary dated 12/29/2023 at 1:08 pm, indicated she had been hospitalized for 9 days for treatment of acute respiratory failure with hypercapnia (respiratory system fails and carbon dioxide [a gas by product that is removed from the body by exhalation] builds up in the body), chronic obstructive pulmonary disease (COPD-a condition of the… […]

• Actual harm, isolatedF686Jun 28, 2023

  Based on observation, interview, and record review, the facility failed to ensure that one resident (Resident 48) who entered the facility without a pressure ulcer (PU), did not develop a pressure sore and that the resident received necessary care and services to promote healing, when Resident 48 was at a risk for PU's upon admit and routine skin assessments did not identify the pressure ulcer at an early stage. Resident 48's PU was identified on 4/7/23 at stage 3 (full thickness tissue loss without muscle, tendon, or bone visible). […]

• Actual harm, isolatedF692Jun 28, 2023

  Based on observation, interview, facility document and Policy and Procedure review, the facility failed to ensure acceptable parameters of nutritional status were maintained for one of 21 sampled residents (Resident 48) when: 1. A Change of Condition (COC) assessment was not completed, and the Physician was not notified of Resident 48's severe weight loss of 12.8 pounds (lbs.), 7.7 % between 1/6/23 and 2/5/23, 15 lbs., 9% between 1/6/23 and 2/7/23, and 17.2 lbs., 10.2% between 8/20/22 and 2/7/23, 2. Weekly weights were not completed as ordered on 1/26/23 for Resident 48, and 3. […]