Glendale Place Care Center

In the surveyor’s words

From the most serious findings on record at Glendale Place Care Center, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Aug 12, 2025

  Based on interview, observation, and facility policy review, the facility failed to ensure staff performed hand hygiene during the meal service. Additionally, the facility failed to ensure staff followed sanitary practices regarding resident refrigerators. These different practices had the potential to affect all residents who received meals from the dietary department. Findings included: 1. An undated facility policy titled, General Food Preparation and Handling, indicated, Employees should wash their hands prior to putting gloves on and after removing gloves. […]

• No harm, potential for more than minimal, patternF567Aug 12, 2025

  Based on record review, interview, and facility document and policy review, the facility failed to allow residents to withdraw greater than $25.00 at a time from their personal funds accounts for 2 (Resident #12 and Resident #87) of 2 residents reviewed for personal funds. This deficient practice had the potential to affect all 55 residents with personal funds accounts managed by the facility. Findings included: An undated Resident Handbook revealed the section titled, Resident Funds Policy Statement, specified, Residents/Authorized representative have access to these funds Monday-Friday from 9:00 a.m. - 5:00 p.m. […]

• No harm, potential for more than minimal, patternF684Jul 5, 2022

  Based on medical record review, staff interview, and review of facility policy, the facility failed to obtain and monitor residents' weights as ordered. This affected five (#49, #222, #223, #53, and #3) of five residents reviewed weights obtained as ordered. The facility census was 78. Findings include: 1. Review of medical record for Resident #49 revealed an admitted [DATE] and discharge date of [DATE]. diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and required extensive assistance with bed mobility, dressing, toileting, and maintaining personal hygiene. The resident required supervision and set up for eating. […]

• No harm, potential for more than minimal, patternF880Jul 5, 2022

  Based on observation, staff interview, and policy review, the facility failed to ensure staff practiced appropriate hand hygiene practices while passing meals trays. This affected 11 (#19, #63, #269, #32, #64, #5, #40, #33, #46, #10, and #50) of 11 residents observed during lunch. This had the potential to affect all 29 residents residing on the 200-hall. The facility census was 78. Findings include: 1. Observation on 06/27/22 at 12:24 P.M. revealed State tested Nursing Assistant (STNA) #300 pushing a meal tray cart of lunch trays down on the 200-hall. STNA #300 retrieved a tray from the cart and entered Resident #19's room. STNA #300 was observed pushing Resident #19 in her wheelchair and repositioning her in front of the meal tray. […]

• No harm, potential for more than minimal, isolatedF609May 21, 2026

  Based on medical record review, review of grievance forms, review of the facility Self-Reported Incident (SRI) log, staff interview, and review of the facility policy, the facility failed to timely report an allegation of misappropriation to the state agency. This affected one (Resident #15) of three residents reviewed for misappropriation. The facility census was 113 residents. Findings include:Review of the medical record for Resident #15 revealed an admission date of 06/21/24 with diagnoses including cerebral infarction, epilepsy, and chronic obstructive pulmonary disease (COPD). Review of the facility grievance form for Resident #15 dated 01/16/26 revealed the resident reported to a nurse he was missing $250.00 and last saw it on 01/11/26. […]