Cottonwood Nursing & Rehabilitation

In the surveyor’s words

From the most serious findings on record at Cottonwood Nursing & Rehabilitation, in the surveyor’s own words.

• Actual harm, isolatedF686Apr 12, 2022

  Based on observation, interview and record review, the facility failed to ensure residents with pressure ulcers received care and treatment consistent with professional standards of practice to promote healing, prevent infection, and prevent new ulcers from developing for one (Resident #2) of two residents observed for wound care. 1. The facility failed to remove Resident#2's footboard on 03/30/22 per the Wound Care physician orders [MEDICAL RECORD OR PHYSICIAN ORDER] . 2. The facility staff failed to attempt alternative preventive measure on when Resident #2 refused to wear the sponge boot per the Wound Care physician orders [MEDICAL RECORD OR PHYSICIAN ORDER] . 3. […]

• No harm, potential for more than minimal, widespreadF812Aug 14, 2025

  Based on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen for food and nutrition services.1. The facility failed to seal, label and date refrigerator and freezer food items.2. Dietary staff failed to dispose of expired foods items in the pantry and refrigerator.These deficient practices could place residents at risk for cross-contamination and foodborne illness.Findings include: Observation on 08/12/2025 from 9:10 AM to 9:45 AM in the facility's kitchen revealed: -Two Sandwiches wrapped in plastic, located in the refrigerator with no label or expiration date. […]

• No harm, potential for more than minimal, patternF689Jan 29, 2026

  Based on observations, interviews, and record reviews, the facility failed to ensure that residents' environment remained free of accident hazards as was possible for accident prevention for 1 of 4 resident halls (Hall 3) observed for safety hazards. The Maintenance Director failed to ensure his toolbox was closed and secure from residents gaining access to it on Hall 3. This failure could result in the residents accessing the toolbox and using tools to potentially harm themselves or others. Findings include: In an observation on 01/29/26 at 09:06 AM, a large toolbox was observed open at the end of Hall 3, unsecured. The toolbox exposed numerous tools, such as a cordless drill, screwdrivers, wrenches, and a hammer, which may be harmful to a resident. […]

• No harm, potential for more than minimal, patternF804Jan 29, 2026

  Based on observations, interviews, and record reviews, the facility failed to ensure that residents' food and drink was palatable, attractive, and at a safe and appetizing temperature for 37 of 39 residents on regular, mechanical, or pureed diets. The Dietary Manager failed to ensure the residents' meals were at a safe and appetizing temperature. This failure could result in the residents consuming food at unsafe temperatures and experiencing unhealthy weight loss. Findings included: In an interview on 01/29/26 at 10:30 AM, Resident #2 stated she was the Resident Council President and for the past 6 months, she and the residents who attended the meeting were complaining about the food being served for all meals. She stated the main concern was the food was always cold. […]

• No harm, potential for more than minimal, patternF558Aug 14, 2025

  Based on observations, interviews, and record review the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for three (Resident #5, Resident #9, and Resident #40) of twenty-one residents reviewed for reasonable accommodation of needs. The facility failed to ensure the call light system in Resident #5, Resident #9, and Resident #40's rooms were in a position that was accessible to the resident on 08/12/2025. This failure could place the residents at risk of being unable to obtain assistance when needed and help in the event of an emergency. […]