Brown's Health and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Brown's Health and Rehabilitation, in the surveyor’s own words.

• Actual harm, isolatedF684Apr 11, 2024

  Based on observations, staff interviews, record review, and review of the facility's policy titled Medication Administration Guidelines, the facility failed to ensure that two residents (R) (R1 and R2) were protected from not following physician orders. Actual harm occurred when pain medication with sedative effects was administered to R1 and R2, which caused them to become lethargic and hard to arouse on 3/6/2024, resulting in both residents being transferred to the emergency room (ER) and treatment with Narcan (reverses an opioid overdose). […]

• Actual harm, isolatedF760Apr 11, 2024

  Based on observations, staff interviews, record review, and review of the facility's policy titled Medication Administration Guidelines, the facility failed to ensure that two residents (R) (R1 and R2) were free of a significant medication error. Actual harm occurred when pain medication with sedative effects was administered to R1 and R2, which caused them to become lethargic and hard to arouse on 3/6/2024, resulting in both residents being transferred to the emergency room (ER) and treatment with Narcan (reverses an opioid overdose). […]

• No harm, potential for more than minimal, patternF584Jul 17, 2022

  Based on observations, interviews, and review of facility document titled Plant Operation Manager the facility failed to ensure that the facility was in good repair as evidence by chipped/peeling paint on handrails on two of four halls (100 hall and 200 hall). The facility also failed to ensure three residents' rooms of nine reviewed (room 2, 3, and 9), were in good repair, specifically all three rooms had chipped/peeling paint on the walls. Findings include: Initial observation on 7/15/22 at 8:59 a.m., room nine revealed air vent loose from wall, paint on wall by vent chipped with sheet rock showing, paint peeling and bulging on the wall above bed A. Initial observations on 7/15/22 at 9:28 a.m. […]

• No harm, potential for more than minimal, patternF563Jun 29, 2021

  Based on observation, record review, review of the facility policy COVID-19 Protocol: Phase IV Re-Opening of Facility Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccinations, review of the Centers for Medicare and Medicaid Services (CMS) QSO-20-39-NH Nursing Home Visitation-COVID 19, family interview and staff interview, the facility failed to ensure that residents were allowed to receive visitors on the weekends for two residents (R) (R A and R B) of three residents reviewed. […]

• No harm, potential for more than minimal, isolatedF554Jan 11, 2026

  Based on observations, staff interviews, record review, and review of the facility's policy titled Resident Self-Administration of Medication, the facility failed to ensure unauthorized medications were not stored at the bedside for one of 27 sampled residents (R) (R25). This deficient practice had the potential to place R25 at increased risk for the use of unauthorized medications. Findings include:Review of the facility's policy titled Resident Self-Administration of Medication, dated 8/3/2025, revealed the Policy section stated It is the policy of this facility to support each resident's right to self -administer medications. A resident may only self-administer medications after the facility's interdisciplinary team has determined which medications may be self-administered safely. […]