Eisenberg Village

In the surveyor’s words

From the most serious findings on record at Eisenberg Village, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF605Feb 26, 2026

  Based on interview and record review, the facility failed to monitor a resident's orthostatic blood pressure (taking blood pressure measurements taken to detect a significant drop in blood pressure when moving from lying/sitting to standing) who was prescribed an antipsychotic medication (a medication used to treat psychosis [a mental condition in which thought and emotions are so affected that contact is lost with external reality]) for 2 (Resident 3 and Resident 10) out of five residents investigated for unnecessary medications. This had the potential for Resident 3 and Resident 10 to have orthostatic hypotension (sudden, severe drop in blood pressure upon standing) side effects such as lightheadedness, syncope (fainting), placing Resident 10 at risk for fall. Findings: a. […]

• No harm, potential for more than minimal, patternF636Feb 26, 2026

  Based on interview and record review, the facility failed to ensure 7 of 7 sampled residents (38, 56, 57, 58, 64, 82, 84) had the Care Area Assessment (CAA) completed within the timeframe outlined on the Resident Assessment Instrument (RAI - a mandatory assessment tool used for the Centers for Medicare and Medicaid Services (CMS)). This failure had the potential to result in inadequate, non-individualized care plans, missed identification of resident risks, and potential for decline in health. Findings: a. […]

• No harm, potential for more than minimal, patternF697Feb 26, 2026

  Based on interview and record review, the facility failed to ensure a resident's pain was assessed and documented on the Medication Administration Record (MAR, a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) before and after pain medication administration for one (Resident 8) of one sampled resident investigated for pain. This deficient practice had the potential to result in ineffective pain management, placing the resident at risk for unrelieved pain. […]

• No harm, potential for more than minimal, patternF755Feb 26, 2026

  Based on interview and record review, the facility failed to: 1.Ensure the Controlled Drug Record (CDR, accountability record of medications that are considered to have a strong potential for abuse) coincided with the Medication Administration Records (MAR, a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) affecting Resident 8 for one of two medication carts (First Floor Team 2 Medication Cart) inspected. This deficient practice had the potential to result in medication error and/or drug diversion (illegal distribution or abuse of prescription drug). 2. […]

• No harm, potential for more than minimal, patternF761Feb 26, 2026

  Based on observation, interview, and record review, the facility failed to label and store drugs and biologicals in accordance with accepted professional principles when the facility: 1.Failed to ensure an eye drop medication was not used past the expiration date for one (First Floor Team Two Medication Cart) of two medication carts that were inspected during the survey. 2.Failed to ensure the label in the Midodrine (given for hypotension or low blood pressure) bubble pack (a method of organizing medications into individual doses, typically sealed in compartments with protective bubbles) is consistent with the physician`s order for the same medication for one of seven residents (Resident 24) observed during the medication administration task. 3. […]