Countryside Manor Nursing and Rehabilitation LLC

In the surveyor’s words

From the most serious findings on record at Countryside Manor Nursing and Rehabilitation LLC, in the surveyor’s own words.

• Immediate jeopardy, patternF880Sep 21, 2021

  Based on the unprecedented global pandemic that resulted in the Presidential declaration of a State of National Emergency dated 03/13/20, Nursing Home Guidance from the Centers for Disease Control (CDC) and Prevention, review of the facility's Coronavirus (COVID-19) policy and procedure, review of the facility's COVID-19 resident and employee positive test results, review of the facility's daily COVID-19 employee screening log, review of timecards, review of text communications, and interviews with staff and the Local Health Department (LHD), the facility failed to implement effective and recommended infection control practices, including following CDC guidelines for excluding health care personnel, who have had contact with someone with suspected or confirmed COVID-19 infection during the… […]

• Immediate jeopardy, isolatedF805Mar 5, 2026

  Based on closed medical record review, staff interview, review of the Emergency Medical Services (EMS) run report, review of hospital records, review of the death certificate, review of staff witness statements, and review of facility policy, the facility failed to ensure residents were served foods in the correct texture to meet individual needs and further failed to ensure residents were accurately assessed for supervision needs during meals. This resulted in Immediate Jeopardy on 01/16/26 for one (#77) resident who experienced serious life-threatening harm and negative health outcomes resulting in death when Certified Nursing Assistant (CNA) #151 served Resident #77, who had a physician ordered mechanical soft texture diet (foods are ground, chopped, or naturally soft), a regular… […]

• Immediate jeopardy, isolatedF689Dec 18, 2023

  Based on medical record review, resident and staff interview, interview with Wound Care Nurse Practitioner (NP) #700, review of hospital records, review of an incident report, review of a facility self-reported incident (SRI), review of the facility investigation, review of witness statements, and review of a policy, the facility failed to ensure a resident (#09) was free from avoidable burns inflicted by a staff member. This resulted in Immediate Jeopardy and the potential for serious life-threatening harm, injuries and/or death when on 12/05/23 at approximately 2:45 A.M., State tested Nurse Aide (STNA) #195 used her personal lighter in an attempt to remove a diabetic wound dressing from Resident #09's right foot. […]

• Actual harm, isolatedF689Jun 3, 2025

  THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY Based on medical record review, resident and staff interview, review of a facility investigation, review of hospital documentation, policy review, and review of facility corrective action documentation, the facility failed to ensure the appropriate level of care and assistance was utilized during resident bathing which resulted in an avoidable fall. Actual harm occurred when Resident #22 was being bathed by one staff member when the resident's care plan indicated the resident required a two-person assist for bathing and the resident's abilities were known to fluctuate. […]

• No harm, potential for more than minimal, widespreadF812May 19, 2026

  Based on observation, staff interview, and review of facility policy, the facility failed to safely store refrigerated and freezer items. This had the potential to affect all residents who receive food from the kitchen. The facility identified one (#45) resident who does not receive food from the kitchen. The facility census was 65. Observation on 05/11/26 at 9:00 A.M. of the walk-in freezer revealed the thermometer was placed in the cooling fan. The thermometer read 20 degrees Fahrenheit. Further observation revealed what appeared to be melted vanilla ice cream on the floor and on the container lids below the ice cream. All six three gallon ice cream containers were soft and felt melted from the outside of the cardboard container. Observation on 05/11/26 at 9:05 A.M. […]