Complete Care at Oak Ridge LLC

In the surveyor’s words

From the most serious findings on record at Complete Care at Oak Ridge LLC, in the surveyor’s own words.

• Actual harm, isolatedF692Jul 25, 2024

  Based on record review and staff interview the facility failed ensure each resident maintains acceptable perimeters of nutrition. They specifically failed to timely assess and/or address a significant weight loss and the resident continued to lose weight. This failure resulted in actual harm for Resident #14. This was true for 1 (one) of 2 (two) residents reviewed for the care area of nutrition during the the Long Term Care Survey Process. Resident identifier: Resident #14. Facility census: 63. […]

• No harm, potential for more than minimal, widespreadF838Jul 25, 2024

  Based on facility record review and staff interview, the facility failed to ensure the facility assessment was modified to make it facility centered to identify the staff competencies required to provide the level and types of care needed for the resident population. This was a random opportunity for discovery during the long term care survey process and had the ability to affect more than a limited number of residents. Identifier: Facility Assessment Tool. Census: 63. Findings included: a) Facility Assessment Tool On 07/24/24 at 10:55 AM during a review of the nursing competency requirements in the facility assessment it is identified that the facility assessment document provided is titled a Facility Assessment Tool. This document update was dated 12/28/23. […]

• No harm, potential for more than minimal, patternF584Aug 26, 2026

  Based on observations, resident interviews and staff interviews. The facility failed to ensure areas of resident rooms and common areas are kept clean, and sanitary. This was a random opportunity found during the survey process and affected more than a limited number of residents. Facility census 74. Findings include a) Review of maintenance work sheet from their work order management system in direct supply, Technology-Enabled Life Safety. (TELS through direct supply) -Record review of the Managed task form for the facilities work order management system revealed a section for the Heating, Ventilation, and Air Conditioning (HVAC) to be done monthly. […]

• No harm, potential for more than minimal, patternF761Aug 26, 2026

  Based on observations, policy review, World Health Organization(WHO) review, staff interview, the facility failed to ensue that drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles to including appropriate accessory and cautionary instructions and the expiration date when applicable. This had the potential to affect more than an isolated number of residents. Facility census: 74. a) Findings include: On 08/24/26 at 12:20 PM, one vial of Tubersol/Tuberculin Purified Protein Derivative (PPD) injectable vial was observed in the medication refrigerator. No date was observed on the box or vial. The vial was half empty of liquid serum. […]

• No harm, potential for more than minimal, patternF812Aug 26, 2026

  Based on observations, policy reviews, and staff interviews the facility failed to ensure the kitchen equipment, preperation tables, and nourishment room were kept clean and free from possible cross contamination. This was found during the survey process and had the potential to affect more than a limited number of residents. Facility census: 74. Findings include: a) Standard practice reads in part. All dry goods will be stored appropriately in accordance with the FDA Food Code. All Time/Temperature Control for Safety foods, frozen and refrigerated, will be stored appropriately in accordance with guidelines of the FDA Food Code. Guidelines read in part: All foods will be stored wrapped or in covered containers, labeled and dated, and arranged to prevent cross-contamination. […]