Handmaker Home for the Aging

In the surveyor’s words

From the most serious findings on record at Handmaker Home for the Aging, in the surveyor’s own words.

• Immediate jeopardy, patternF600Sep 12, 2025

  Based on observations, clinical record reviews, interviews, and review of facility policy and procedures, the facility failed to protect the rights of one resident (#1) to be free from verbal and physical abuse by another resident (#2). The deficient practice resulted in psychosocial harm to resident #1 and the potential for abuse of other residents. As a result, the condition of Immediate Jeopardy (IJ) and Substandard Quality of Care was identified.Findings include:On September 10, 2025, at 4:10 PM, a condition of IJ was identified. The administrator (staff #110) and the assistant administrator (staff #103) were informed of the facility's failure to ensure resident #1 was protected from abuse by resident #2. […]

• No harm, potential for more than minimal, patternF607Sep 12, 2025

  Based on clinical record reviews, interviews, and review of facility policy and procedures, the facility failed to implement their policies and procedures on resident protection, abuse reporting and investigation of an allegation of verbal and physical abuse for one resident (#1) by another resident (#2). The deficient practice resulted in further abuse of resident #1 Findings include:-Resident #3 (witness) was admitted on [DATE] with diagnoses of dementia, abnormalities of gait and mobility and muscle weakness.The late entry provider visit note dated August 19, 2025 revealed the resident was alert, oriented 2-3, ambulated with 1-person assist and had no focal neurological deficits. […]

• No harm, potential for more than minimal, patternF609Sep 12, 2025

  Based on clinical record reviews, interviews, and review of facility policy and procedures, the facility failed to ensure allegations of verbal and physical abuse of one resident (#1) by another resident (#2) was reported to the State Agency (SA) and Adult Protective Services (APS). The deficient practice could result in abuse not investigated and resident not protected from further abuse.Findings include:-Resident #3 (witness) was admitted on [DATE] with diagnoses of dementia, abnormalities of gait and mobility and muscle weakness.The late entry provider visit note dated August 19, 2025 revealed the resident was alert, oriented 2-3, ambulated with 1-person assist and had no focal neurological deficits. […]

• No harm, potential for more than minimal, patternF610Sep 12, 2025

  Based on clinical record reviews, interviews and review of facility documentation, policies and procedures, the facility failed to ensure allegations of verbal and physical abuse of one resident (#1) by another resident (#2) were thoroughly investigated and appropriate corrective actions were taken. The deficient practice could result in resident not protected from further abuse.Findings include:-Resident #3 (witness) was admitted on [DATE] with diagnoses of dementia, abnormalities of gait and mobility and muscle weakness.The late entry provider visit note dated August 19, 2025 revealed the resident was alert, oriented 2-3, ambulated with 1-person assist and had no focal neurological deficits. […]

• No harm, potential for more than minimal, patternF677Jan 22, 2025

  Based on staff interviews, clinical record review and facility policy, the facility failed to ensure that resident #16 was provided with assistance with activities of daily living (ADL) to maintain personal hygiene. Failure to meet this requirement could lead to issues with skin integrity and impairing resident dignity. Findings include: Resident #16 was admitted [DATE] with diagnoses of dementia, Bipolar disorder and Major Depressive Disorder. An quarterly Minimum Data Set, dated dated dated [DATE] included that this resident was severely cognitively impaired and was dependent for showering/bathing self and dependant for the ability to get in or out of a tub/shower. A care plan dated June 9, 2020 included that this resident has an ADL self-care deficit related to dementia. […]