Eagleridge Health and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Eagleridge Health and Rehabilitation Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Apr 23, 2026

  Based on record review, review of facility's policies and procedures, resident and staff interviews, the facility failed to protect the resident's right to be free from neglect for 1(Resident #1) of 3 residents reviewed.The facility failure to prevent the neglect of Resident #1 created a likelihood of serious harm or death of the resident from exposure to excessive heat which can cause heat related illness, including heat exhaustion and heat stroke and resulted in the determination of Immediate Jeopardy (IJ).On 4/23/26, after verification of an acceptable Immediate Jeopardy removal plan, the Immediate Jeopardy was removed, effective 4/16/26.The findings of Immediate Jeopardy were determined to be corrected on 4/21/26.The findings included:Review of the facility's policy and procedure… […]

• Actual harm, isolatedF627Apr 2, 2026

  Based on record review, and interviews, the facility failed to provide a safe and appropriate discharge for 2 (Residents #1and #2) of 3 residents reviewed for transfer and/or discharges. The facility failed to confirm Resident #1's transportation, causing the resident to leave the facility in her wheelchair after waiting over two hours and attempt to wheel herself to her discharge location which is located 10 miles from the facility.The findings included:Review of the facility Transfer and Discharges policy (last revised 2/2024) revealed, The facility will develop and implement an effective discharge process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care . […]

• Actual harm, isolatedF689Jan 30, 2025

  Based on interview and record review the facility failed to ensure adequate supervision to prevent one resident (resident #1) of three residents sampled for falls to prevent multiple falls and major injuries to the resident, multiple falls, a fracture of to the right hip on 11/1/24 for which the resident was hospitalized for surgical intervention, and a fracture to the to the right humorous on 11/17/24. The findings included: Review of facility titled, Falls- Managing, Preventing and Documentation, revised 1/2024, which stated, Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling . […]

• Actual harm, isolatedF689Feb 8, 2024

  Based on record review, review of facility policy and procedures, and staff interviews, the facility failed provide the necessary supervision and assistance to prevent multiple falls for 1 (Resident #999) of 3 residents reviewed for falls. On 1/9/24, and 2/1/24, Resident #999 was not adequately supervised and fell . Each time the resident sustained a laceration to her face resulting in a transfer to an acute care hospital. The findings included: The facility policy Falls, Managing, Preventing and Documentation (revised 1/24) documented Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try and prevent the resident from falling and try to minimize complications from falling. […]

• Actual harm, isolatedF686Mar 24, 2022

  Based on observation, record review, review of facility's policy and procedure, and staff interviews, the facility failed to ensure 1 (Resident #410) of 2 sampled residents at risk for development of pressure ulcers received necessary services to prevent the worsening and development of pressure ulcers. Resident #410's pressure ulcer significantly deteriorated, and the resident developed additional pressure ulcers. The findings included: Review of the Facility's Skin Management Guidelines with an original date of 2/2022 revealed, Purpose: To describe the process steps required for identification of patients at risk for the development of skin alterations, identify, prevention techniques and interventions to assist with the management of pressure injuries and skin alterations . […]