Brightwood Center

In the surveyor’s words

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

• Immediate jeopardy, widespreadF600May 27, 2025

  Based on resident interview, staff interview and record review, the facility failed to ensure residents were free from sexual and psychosocial abuse perpetrated by another resident . This created an immediate jeopardy situation and put all residents at risk. Resident identifier's: #97 and #102. Facility Census: 111. Findings included: a) Resident #97 At approximately 09:05 AM on 05/20/2025, Resident #97 reported to a surveyor she was abused by Resident #58. Resident #97 stated Resident #58 hit her with her wheelchair and put her hand up my crotch. The resident stated she reported the alleged abuse to Nurse Aide (NA) #63 who, instead of reporting it, made fun of her and laughed while stating, Didn't you like it? The resident stated she told NA #63 she did not like it. […]

• Immediate jeopardy, widespreadF835May 27, 2025

  Based on record review and resident and staff interview, the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident by failing to take actions related to allegations of abuse/neglect, when reported by staff. This had the potential to adversely affect all residents residing in the facility. The State Agency (SA) determined these failures caused Resident #97 to suffer sexual abuse and psychosocial harm. Due to the facility's failure to act on the allegation of sexual abuse when they were made aware not only placed Resident #97 at risk for sexual abuse and psychosocial harm but also placed the remaining 110 residents. […]

• Immediate jeopardy, isolatedF607May 27, 2025

  Based on resident interview, staff interview and record review, the facility failed to ensure residents were free from sexual abuse by not implementing written policies for abuse and following policy and procedures to investigate abuse allegations. This was true for one(1) of six (6) residents reviewed for abuse. This failed practice has the potential to affect more than a limited number of residents. The situation was determined to be an Immediate Jeopardy situation due to all residents residing in the facility could experience serious actual or psychological harm if the facility did not immediately intervene. Resident identifier: #97. […]

• No harm, potential for more than minimal, widespreadF584May 27, 2025

  Based on observation, resident and staff interview the facility failed to provide the right to a safe, comfortable and homelike environment by not providing residents access to over the bed lights. This was a random opportunity of discovery. Facility Census: 111 Findings Include: a) On 5/19/25 at 12:45 PM a resident voiced her concern that she could not see very well while reading in her bed. She believed the light bulb needed to be brighter. Upon further investigation it was found that there was a light fixture over each resident's bed. There was a toggle switch to the right of each fixture. […]

• No harm, potential for more than minimal, widespreadF732May 27, 2025

  Based on record review and staff interview, the facility failed to ensure posted nurse staffing information was accurate, by failing to update the posting. This was a random opportunity for discovery. This has the potential to affect more than a limited number of residents residing in the facility. Facility census: 111. Findings include: a) During staffing review, daily nurse staff postings were reviewed. During that review, it was determined that the facility failed to accurately update the posted information. The following days were reviewed and compared with the facility's punch in and out reports, with discrepancies: -11/16/2024- No census was indicated on the staffing sheet. Total direct care hours are 309.38 on the staffing sheet. […]