Capital Post Acute

In the surveyor’s words

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

• Actual harm, isolatedF695Aug 2, 2022

  Based on interview and record review, the facility failed to adhere to established facility policy and procedures and nationally recognized standards of practice for 1 of 3 sampled residents (Resident 1) when: 1. The secondary (hallway) ventilator (a machine designed to provide mechanical breathing by moving air into and out of the lungs when a person is unable to perform the function for themselves) alarm (an auditory and visual notification system designed to alert staff of ventilated resident problems) was disabled; 2. The primary ventilator (on the machine itself) alarm was reduced to the minimum auditory level; and 3. […]

• Actual harm, isolatedF600Jun 29, 2022

  Based on interview and record review, the facility failed to ensure Resident 1 was free from physical abuse when Resident 1 was held down and had a towel placed over her face when Certified Nurse Assistants (CNAs) provided care. This failure resulted in Resident 1 to have expressed fear and anxiety and experienced pain in the arm and discoloration on bilateral forearms. Findings: Resident 1 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of Resident 1's Quarterly MDS (Minimum Data Set-an assessment tool), dated 9/3/21, described Resident 1 as able to make herself understood and as having the ability to understand others. […]

• No harm, potential for more than minimal, patternF880Aug 14, 2026

  Based on observation, interview, and record review, the facility failed to ensure consistent infection prevention and control practices and guidelines for a safe, sanitary and comfortable environment and to prevent the transmission of infections and foodborne illnesses were provided to a census of 199, when:Certified Nurse Assistant 1 (CNA 1) did not wear complete Personal Protective Equipment (PPE, refers to specialized gear and clothing, such as gloves, masks, gowns, goggles, and face shields worn by healthcare workers to create a physical barrier, which protects the wearer from infectious germs, blood, and harmful body fluids, while also stopping the spread of illness between patients) indicated for enhanced barrier precaution (EBP, infection control guidelines used in nursing homes to… […]

• No harm, potential for more than minimal, patternF603Feb 20, 2026

  Based on observation, interview, and record review the facility failed to ensure nine residents (Resident 32, Resident 17, Resident 59, Resident 84, Resident 94, Resident 122, Resident 71, Resident 36 and Resident 126) out of 32 sampled residents were free from involuntary seclusion when resident room doors were left closed.This failure had the potential to increase the risk of psychosocial trauma and physical injury when residents were unable to exit their rooms independently or access staff during an emergency. […]

• No harm, potential for more than minimal, patternF759Feb 20, 2026

  Based on observation, interview, and record review, the facility failed to ensure four residents (Resident 139, Resident 96, Resident 116 and Resident 126) of 32 sampled residents were free of medication administration error rates of five percent or more, when 10 errors out of 28 opportunities for errors occurred during the medication administration to the residents.These failures resulted in medication administration error rates of five percent or more, which was 35.71 %. Findings:1. During a medication administration observation on 2/18/26 at 8:08 a.m., with Licensed Nurse (LN) 5, LN 5 was observed preparing four medications for Resident 139.During a concurrent interview and record review on 2/18/26 at 8:42 a.m., with LN 5, Resident 139's medical record was reviewed. […]