Eagle Pointe Skilled Nursing & Rehab

In the surveyor’s words

From the most serious findings on record at Eagle Pointe Skilled Nursing & Rehab, in the surveyor’s own words.

• Actual harm, isolatedF760Jan 10, 2024

  Based on record review, review of psychotropic medication information, facility policy review and interview, the facility failed to prevent a significant medication error for Resident #26 when the resident's psychotropic medication, for reducing risk of recurrent suicidal behavior with schizophrenia was not administered as ordered by the physician from 11/20/23 until 12/06/23. The facility also failed to ensure the physician was notified timely that the medication was unavailable for administration. […]

• No harm, potential for more than minimal, widespreadF803Mar 26, 2024

  Based on observation, interview, and review of facility documents, the facility failed to ensure they had a three-day emergency supply of food as required. This had the potential to affect all 54 residents. The facility identified no residents as receiving nothing by mouth. The census was 54. Findings include: Observation during initial tour of the kitchen on 03/25/24 from 8:03 A.M. to 8:25 A.M. with Dietary Cook (DC) #355 and Dietary Aide (DA) #356 revealed a minimal supply of foods in dry and cold storage areas of the kitchen. The walk-in cooler and freezer revealed the shelves held minimal foods available to cook for the meals. The bread rack had multiple empty shelves with a few packages of bread products. […]

• No harm, potential for more than minimal, widespreadF812Mar 26, 2024

  Based on observation, interviews, review of facility records and review of facility policy, the facility failed to ensure the low temperature dish machine was being appropriately monitored for levels of chemical sanitizer, and the kitchen was clean and sanitary. This had the potential to affect all 54 residents. The facility identified no residents as receiving nothing by mouth. The census was 54. Findings include: 1. Observation of the low temperature dish machine on 03/25/24 from 9:05 A.M. to 9:13 A.M. with Regional Director (RD) #353 revealed the dish machine had not met the recommended sanitation level of 50 parts per million (ppm) when RD #353 tested the dish machine's rinse water with a QAC QR Code 2951 sanitation test strip. […]

• No harm, potential for more than minimal, patternF602Apr 8, 2026

  THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY.Based on record review, interview, observation, self-reported incident (SRI) review and facility policy review, the facility failed to ensure residents were free from misappropriation. This affected five Residents (#20, #35, #46, #54, and #55) out of six residents reviewed for misappropriation. The facility census was 53.Findings include:1. Review of the closed medical record for Resident #54 revealed an admission date of 02/19/24. She passed away at the facility on 08/28/25. Her diagnoses included rheumatoid arthritis, chronic pain, and chronic obstructive pulmonary disease (COPD). […]

• No harm, potential for more than minimal, isolatedF585Apr 30, 2026

  Based on record review, resident and staff interviews and facility policy review, the facility failed to make prompt efforts and resolve a resident grievance involving staff smelling of marijuana while providing care. This affected one resident (Resident #21) of two residents reviewed for resident concerns. The facility census was 53. Findings include:Review of the medical record for Resident #21 revealed an admission date of 07/15/23 with diagnoses including pan lobular emphysema, chronic obstructive pulmonary disease (COPD), insomnia, dependence on respirator, muscle wasting, heart failure, type two diabetes, and anxiety. […]