Hartland Park Health & Rehabilitation

In the surveyor’s words

From the most serious findings on record at Hartland Park Health & Rehabilitation, in the surveyor’s own words.

• Immediate jeopardy, patternF880Sep 10, 2021

  Based on observation, interview, record review, and review of the facility's policies, it was determined the facility failed to establish and maintain an infection prevention and control (IPC) program designed to provide a safe, sanitary, and comfortable environment and to help prevent and control the development and transmission of communicable diseases. The facility also failed to implement interventions per the Centers' for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Kentucky Department for Public Health (Health Department) State guidelines for COVID-19 for fifteen (15) out of one-hundred fourteen (114) sampled residents (Residents #2, #4, #9, #10, #12, #13, #14, #15, #16, #17, #18, #19, and #20). […]

• Actual harm, isolatedF656Aug 16, 2024

  Based on observation, interview, record review, and review of the facility's policy, the facility failed to develop or implement 2 of 36 sampled residents' Comprehensive Care Plans (CCP), Resident (R) 124 and R36. R124 returned from the hospital and reported pain, but she did not receive ordered pain medication for approximately 21 hours after it was ordered, despite care planning to administer medications per orders. (Cross Reference F689) R36's CCP was not developed with interventions to address the resident's and family's non-compliance with R36's current diet order. […]

• Actual harm, isolatedF697Aug 16, 2024

  Based on interview, record review, and review of the facility's policies, the facility failed to administer prescribed pain medications timely for 1 of 2 sampled residents, Resident (R) 124. R124 returned to the facility on [DATE] at 12:30 PM, and orders were written for Oxycodone 5 milligrams (mg) every 12 hours as needed (an opioid pain medication) and Oxycodone 15 mg every six hours, for R124's fracture of the right and left femur. Observations and interviews revealed two Oxycodone 5 mg and two Oxycodone 5 mg/325 mg acetaminophen (a non-narcotic pain medication) were available in the medication emergency box, however, staff were unaware the medications were available to the resident. In addition, R124 first expressed pain to staff on 03/01/2024 at 3:10 PM. […]

• No harm, potential for more than minimal, widespreadF812Jul 2, 2026

  Based on observation, interview, review of a manufacturer's recommendations, and review of the facility's documents, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety, which had the potential to affect all 138 current residents.1. Observations of the kitchen on 06/29/2026 and 06/30/2026 revealed poor lighting throughout the kitchen production area and grease on the floor near the door of the dry storage room. Further, review of the facility's documents revealed issues with cleanliness in the kitchen from 04/29/2026 to 06/08/2026.2. Observation of two of three nourishment rooms on 06/30/2026 revealed the Combs Unit nourishment refrigerator contained a Med-Plus supplement, which was opened but not dated. […]

• No harm, potential for more than minimal, widespreadF880Jul 2, 2026

  Based on observation, interview, record review, and review of the facility's policy, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent and control the development and transmission of communicable diseases. The facility failed to identify and correct problems related to infection prevention practices that had the potential to affect all residents in three of the three sampled shower rooms.Observations on 07/02/2026 of the [NAME], [NAME], and Combs Units Spa revealed the shower areas were used to store clean linens, which were uncovered, and shared resident use equipment. […]