Heartland Nursing & Rehab

In the surveyor’s words

From the most serious findings on record at Heartland Nursing & Rehab, in the surveyor’s own words.

• Actual harm, isolatedF689Apr 19, 2022

  Based on observation, interview and record review the facility failed to supervise a resident while on the toilet (R1), failed to implement post fall interventions (R2) and failed to lock an unattended treatment cart (R2) for two of three residents (R1, R2) reviewed for falls in the sample list of three. This failure resulted in R1 falling and sustaining a 3 cm (centimeter) laceration and receiving 5 stitches in the emergency room . Findings include: The facility's Falls and Fall Risk, Managing policy with a revised date of March 2018 documents, Policy Statement Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from… […]

• No harm, potential for more than minimal, widespreadF812Jan 29, 2026

  Based on observation, interview and record review the facility failed to store food in accordance with professional standards for food service safety. This failure has the potential to affect all 53 residents residing at the facility.The Long-Term Care Facility Application for Medicare and Medicaid form dated 1/26/26 documents 53 residents reside in the facility. On 01/27/2026 at 11:51 AM the facility's walk-in cooler was observed with a dark brown substance puddled onto the floor beneath a rack of raw meat. A large portion of meat wrapped in plastic was sitting on a cardboard box on the bottom shelf of the cooler with accumulating fluids on top of the box that were dripping down the side of the box. […]

• No harm, potential for more than minimal, widespreadF868Jan 29, 2026

  Based on interview and record review, the facility failed to have quarterly Quality Assessment Performance Improvement (QAPI) meetings and failed to ensure required staff members attended meetings. These failures have the potential to affect all 53 residents residing in the facility. Findings include: On January 28, 2026, V1, Administrator provided three sign-in sheets for the facility's Quality Assessment and Assurance (QAA) Committee dated 10/28/25, 7/17/25 and 3/14/25.On 1/28/26 at 1:15 PM V1, stated these are the only sign-in sheets I have for QAA meetings. The QAA sign in sheet dated 7/17/25 does not document V15 Medical Director's signature. […]

• No harm, potential for more than minimal, widespreadF880Jan 29, 2026

  Based on interview and record review the facility failed to implement a Legionella surveillance program. This failure has the potential to affect all 53 residents who reside in the facility.Findings Include:The facility's Long-Term Care Application for Medicare and Medicaid Services form dated 1/26/26 documents 53 residents residing at the facility.The facility's Safe Water Policy dated 2/1/24 states Maintenance Supervisor must be able to demonstrate sound knowledge and specific skills in service being provided. This may include the maintenance of water systems equipment/services such as: Water storage tanks, vessels, and connecting pipework above and below ground. Sanitary appliances and associated taps, thermostatic mixing valves, and other fittings. […]

• No harm, potential for more than minimal, widespreadF801Dec 13, 2024

  Based on observation, interview, and record review, the facility failed to provide the services of a qualified director of food and nutrition services. This failure affects all 42 residents residing in the facility. Findings Include: On 12/10/24 at 9:55 AM, V5, Dietary Manager, was actively supervising and directing the food preparation and wares sanitation processes in the facility kitchen. At 11:50 AM and 12:08 PM, V5 was actively supervising and directing the meal service for lunch. On 12/10/24 at 9:55 AM, V5 stated she was the Dietary Manager. V5 further stated she had a (national company) cooking sanitation certificate. […]