Christian Care Nursing Center

In the surveyor’s words

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

• Actual harm, isolatedF684Apr 17, 2024

  Based on interview and record review, the facility failed to ensure admission orders were thoroughly reviewed and transcribed accurately, and pertinent physical assessment findings recognized and promptly addressed for 1 resident (Resident #49) out of 3 closed records reviewed, resulting in two hospitalization s due to missed orders and failure to address a change in condition in a timely manner. Findings: Resident #49 (R49) Review of an Admission Record reflected R49 admitted to the facility on [DATE] with diagnoses that included sepsis, localized edema, atrial fibrillation, sick sinus syndrome, atrial flutter, pulmonary hypertension, high blood pressure, acute embolism and thrombosis of unspecified deep veins of lower extremity, muscle weakness and bladder neck obstruction. […]

• Actual harm, isolatedF684Mar 7, 2024

  Based on interview and record review, the facility failed to ensure appropriate neurological assessments were completed for 1 resident (Resident #1) out of 4 residents reviewed for falls, resulting in the potential for a delay in treatment after an unrecognized acute change in condition. Findings include: Resident #1 (R1) Review of an Admission Record revealed R1 admitted to the facility with pertinent diagnosis that included a history of a stroke, high blood pressure, osteoporosis and a history of a traumatic fracture. Review of R1's Progress Notes in the Electronic Medical Record (EMR) indicated R1 sustained an unwitnessed fall on 12/16/23 at approximately 10:15 p.m. R1 had another unwitnessed fall on 12/17/23 sometime before 5:00 a.m. […]

• Actual harm, isolatedF600Dec 29, 2022

  This citation pertains to intakes: MI00130551 and MI00132977 Based on interview and record review, the facility failed to prevent abuse and neglect for 2 residents (Resident #3 and #5) reviewed for abuse and neglect, resulting in the physical and verbal abuse of R3 and the neglect of R5 and the potential for serious physical and psychosocial harm. Findings: On 12/19/2022 an abbreviated survey was commenced to review Facility Reported Incidents (FRIs) pertaining to alleged abuse and neglect. The facility census during the survey was 23. […]

• Actual harm, isolatedF689Sep 9, 2021

  This citation pertains to intake MI 2349 Past non-compliance was accepted for this citation. Plan identified below. Based on observation, interview, and records review, the facility failed to safely transfer one resident (Resident #1) resulting in a fall and serious injury requiring a transfer to the hospital and surgery to treat an impacted and angulated intertrochanteric fracture of the right proximal femur. Findings: Review of a facility policy Assessment and Procedures for Safe Lifting and Moving of Residents last reviewed 1/4/2021 reflected To protect the safety and well being of residents, staff and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. […]

• No harm, potential for more than minimal, widespreadF812Mar 27, 2025

  Based on observation, interview, and record review, the facility failed to prepare food in accordance with professional standards for food service safety. This deficient practice has the potential to result in food borne illness among all residents that consume food from the kitchen. Findings include: During the initial tour of the kitchen, at 9:40 AM on 3/25/25, and interview with Certified Dietary Manager (CDM) R found that the facility rarely cools down food from service or makes large meals in advance that require a cooling and reheating step before being served. Observation of the walk-in cooler, at 9:42 AM on 3/25/25, found a six inch deep quarter pan of gravy dated 3/24/25. At this time, a temperature of the gravy was found to be 42F. […]