Columbia Lutheran Home

In the surveyor’s words

From the most serious findings on record at Columbia Lutheran Home, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Mar 20, 2025

  Based on observation, interview, and record review, the facility failed to ensure foods were stored and handled appropriately in accordance with professional standards of food safety for 2 of 2 kitchen refrigerators (Kitchen Reach-In refrigerator and Kitchen Walk In refrigerator), 1 of 1 kitchen dry storage room, 2 of 7 unit refrigerators ([NAME] dining room pantry white refrigerator and [NAME] pantry silver refrigerator), 1 of 3 dining rooms ([NAME] dining room), and 2 of 4 halls (Dogwood and [NAME]), reviewed for food services. […]

• No harm, potential for more than minimal, widespreadF732Feb 28, 2024

  Based on observation, interview, and record review, the facility failed to ensure the posted daily nurse staffing information included the actual hours worked by registered and licensed nursing staff directly responsible for resident care per shift for 58 of 58 days (01/01/2024 to 02/27/2024), reviewed for posted nurse staffing information. The failure to post a complete and accurate form daily prevented the residents, family members, and visitors from exercising their rights to know the actual nursing staff hours worked in the facility. […]

• No harm, potential for more than minimal, widespreadF812Feb 28, 2024

  Based on observation, interview, and record review, the facility failed to ensure foods were handled appropriately in accordance with professional standards of food safety for 2 of 4 refrigerators (Kitchen and Dining Room Refrigerators) and 2 of 2 (Kitchen's Freezer and Walk-In Freezer) freezers reviewed for food services. The failure to label and discard expired food items and/or before use by date, placed the residents at risk for food borne illness (caused by the ingestion of contaminated food or beverages), cross contamination, and a diminished quality of life. Findings included . […]

• No harm, potential for more than minimal, patternF697Jul 8, 2026

  Based on interview and record review, the facility failed to initiate non-pharmacological interventions for pain management prior to administering as needed (PRN) pain medication for 3 of 6 residents (Residents 3, 14 & 39), reviewed for pain management. This failure placed the residents at risk for unnecessary medications and incomplete pain control. Findings included. Review of the facility's undated policy titled, Pain Management, showed that the facility would ensure that pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences. […]

• No harm, potential for more than minimal, patternF699Jul 8, 2026

  Based on observation, interview, and record review, the facility failed to ensure residents who were trauma survivors and diagnosed with Post Traumatic Stress Disorder (PTSD - a mental health condition triggered by a terrifying event that was either experienced or witnessed) was adequately assessed and/or care planned for trauma-informed care and associated triggers in accordance with professional standards of practice for 3 of 3 residents (Residents 2, 7, & 56), reviewed for mood/behavior. […]