Brookside Care Center

In the surveyor’s words

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

• Immediate jeopardy, patternF695Aug 13, 2025

  Based on observation, interview, and record review, the facility failed to provide respiratory care (the diagnosis, treatment, and management of residents with breathing or other cardiopulmonary (heart and lung) disorders) consistent with professional standards of practice for two of two sampled residents (Resident 1 and Resident 2) with a tracheostomy (an opening surgically created through the neck into the trachea (windpipe) to allow air to fill the lungs) when: 1. Registered Nurses (RNs) provided care for Resident 1 and Resident 2 without documented competencies (measurable patterns of knowledge that enabled individuals to perform a skill successfully) for tracheal suctioning (a procedure that cleared mucus (a sticky substance produced by the body) and secretions (liquid substance… […]

• Actual harm, isolatedF600Aug 20, 2026

  Based on observation, interview, and record review, the facility failed to protect two of two resident's (Resident 1 and Resident 2) right to be free from physical abuse by a resident when, Resident 3, who had a history of known violent behaviors, entered the common area of the facility and pushed Resident 2 on 8/11/26 and on 8/12/26 walked up to Resident 1, slapped her on the face and pushed her to the ground.This failure resulted in Resident 1 feeling angry about the incident and Resident 2 sustaining bruising, pain, and a fracture (broken bone) of her right arm. […]

• Actual harm, isolatedF605Jul 28, 2026

  Based on interview and record review, the facility failed to ensure that one of three resident's (Resident 1) drug regimen (a detailed plan for taking medication) was free from unnecessary drugs, failed to obtain informed consent (ICO -process where a doctor explains a mind-altering medication, its risks, and benefits, alternatives, ensuring the patient or legal guardian agrees freely before treatment) for the use psychotropic medication (mind altering drugs) prior to Resident 1 starting the medications, failed to monitor for adverse side effects (ASE -harmful, negative, unintended reactions caused by medication treatment) of multiple psychotropic medications with black box warnings (BBW -life threatening risks), and failed to assess, intervene, and transfer Resident 1 to an acute care… […]

• Actual harm, isolatedF689Oct 30, 2025

  Based on observation, interview, and record review, the facility failed to ensure one of three sampled residents (Resident 1) was provided with an environment free from accident hazards when certified nursing assistant (CNA) 1 provided care to Resident 1 alone, but based on Resident 1's assessed needs required two staff members, and Resident 1 had an air mattress (a mattress that works by using air chambers that redistribute pressure, improve blood flow, and reduce friction for residents with limited mobility) placed on his bed without a physician's order or monitors in place to ensure the correct settings were maintained. […]

• No harm, potential for more than minimal, widespreadF812Jan 16, 2024

  Based on observation, interview, and record review, the facility failed to meet food storage and food service practices that met professional standards for food service safety when: 1) Kitchen staff did not consistently use a beard guard while in the kitchen, 2) Food not consistently labeled appropriately, 3) Expired foods were not discarded, 4) Refrigerated and frozen food was not consistently covered, 5) Ice build-up was found around the freezer door and fans, 6) Grime and debris was found on kitchen equipment, 7) Kitchen had multiple walls with large areas of chipped paint showing dry wall, rusted equipment, and corroded metal surfaces, 8) Dishwasher gauge was not consistently showing wash temperature; and, 9) Resident refrigerator with food items was not consistently labeled. […]