Hawthorne Center for Rehabilitation and Healing of

In the surveyor’s words

From the most serious findings on record at Hawthorne Center for Rehabilitation and Healing of, in the surveyor’s own words.

• Immediate jeopardy, patternF684Jun 17, 2025

  Based on interviews, record reviews, and review of policy and procedures, the facility failed to ensure residents with prescribed controlled medications were administered the medications per the physician order when failing to contact the physician when prescriptions were needed and the medications were not administered for three of three residents reviewed for medication administration (Residents #7, #9, and #10). Resident #7, with a history of prescribed Alprazolam use, was admitted into the facility on 6/11/2025 and had been prescribed Alprazolam four times a day. Resident #7 suffered withdrawal symptoms of sweating, shaking, insomnia, and increased pain. There was a delay in administering Alprazolam until 6/13/2025 at 9:00 PM resulting in nine missed doses. […]

• Immediate jeopardy, patternF835Jun 17, 2025

  Based on interviews, record reviews, and review of policies and procedures, the facility administration failed to administer the facility in a manner that enables it to use its resources effectively and efficiently to attain and maintain the highest practicable physical wellbeing of each resident by failing to implement policy and procedures for medication administration. The facility failed to ensure residents with prescribed controlled medications were administered the medications per the physician order when failing to contact the physician when prescriptions were needed and the medications were not administered for three of three residents reviewed( Residents #7, #9, and #10). […]

• No harm, potential for more than minimal, widespreadF812Apr 7, 2022

  Based on observation, interview, and record review, the facility failed to ensure foods are labeled, dated, covered, and stored under sanitary conditions. Findings: An observation during the initial walk through of the kitchen on 4/4/22 at 9:15 AM shows 14 clear swirl cups containing what appeared to be pudding located in the reach-in cooler/refrigerator on a tray. The tray and the individual swirl cups did not have an identifier of the food item or the date it was prepared for service to the residents. On the rack in the stock/dry storage room storing the active use food items there is a can of apricots that is dented on the top and the bottom of the can and the can is swollen and a of corned beef that is dented at the top of the can and the can is swollen. […]

• No harm, potential for more than minimal, patternF695May 29, 2026

  Based on observation, interview and record review the facility failed to administer oxygen at the correct flow rate according to physician orders for 2 residents ( Resident #58 and #116) and failed to have physician orders documenting the prescribed flow rate for 1 resident ( Resident #130) of 5 residents reviewed for oxygen therapy. Findings include: During an observation on 5/26/2026 at 10:49 AM Resident #58 was observed with oxygen at 3 liters via a nasal cannula. During and observation on 5/27/2026 at 7:26 AM Resident #58 was observed with oxygen at 3 liters via a nasal cannula. […]

• No harm, potential for more than minimal, patternF812May 29, 2026

  Based on observation interview and record review the facility failed to ensure food was stored and served in a sanitary manner. Findings include: Observation of the walk in freezer on 5/26/2026 at 9:34 AM showed there was no stand alone thermometer in the walk-in freezer. During interview on 5/26/2026 at 9:35 AM, the Certified Dietary Manager confirmed there was no stand alone thermometer in the walk-in freezer. Service of the midday meal was observed on 5/29/2026 beginning at 11:20 AM. The cook was observed using a gloved hand to scoop and place meal items onto plates and touching the counter top. The cook was then observed lifting a cheese slice from a stack of cheese with her same gloved hand and placing the slice of cheese onto a hamburger bun for service to a resident. […]