Heartwood Extended Healthcare

In the surveyor’s words

From the most serious findings on record at Heartwood Extended Healthcare, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Dec 15, 2022

  Based on interview and record review the facility failed to ensure staff performed Cardio-Pulmonary Resuscitation (CPR) to 1 of 1 resident (Resident 1) who was found unresponsive and had a POLST (Physician's Orders for Life Sustaining Treatment) that indicated the resident wanted to receive life-sustaining care and services. This failure resulted in the resident's wishes not being followed and placed other residents at risk of not receiving needed emergency medical interventions for unexpected emergencies. The facility corrected the above deficient practice prior to the abbreviated survey. […]

• Actual harm, isolatedF690Aug 26, 2026

  Based on interview and record review the facility failed to provide care for an indwelling urinary catheter (a flexible tube placed inside the bladder to drain urine continuously into an external bag), according to physician orders and plan of care, for 1 of 5 sample residents (Resident 1) reviewed for catheter care. Resident 1, who had a know history of catheter related infections, experienced harm from staff failing to flush their catheter leading to a hospitalization for bacteremia (when bacteria enters the blood stream). This failure placed facility residents at risk of infection, poor clinical outcomes and a decreased quality of life.Findings included. […]

• Actual harm, isolatedF689Mar 30, 2026

  Based on interview and record review, the facility failed to identify fall trends, evaluate the effectiveness of previous fall prevention interventions and to implement progressive resident centered interventions for 1 of 2 sampled residents (Resident 66) reviewed for falls. Resident 66, who had six falls in 10 weeks (two unwitnessed non-injury and four unwitnessed with injury), experienced harm when they fell, sustained a fracture of their right distal clavicle (collar bone) that required transfer to the emergency department for evaluation and treatment. This failure placed residents at risk of repeated falls and injuries. […]

• Actual harm, isolatedF684Apr 12, 2024

  Based on observation, interview, and record review, the facility failed to accurately assess and develop/implement a care plan (CP) for the management of chronic heart problems and failed to timely identify/assess/implement interventions for a related change in condition for 1 of 3 sampled Residents (Resident 51) reviewed for hospitalization . The facility also failed to consistently monitor and document bowel movements (BMs) and implement the bowel program when needed for 2 of 3 sampled residents (Residents 16 and 66) reviewed for bowel management. […]

• Actual harm, isolatedF689Mar 27, 2024

  Based on observation, interview, and record review the facility failed to ensure an environment free of avoidable accidents/hazards for 1 of 7 residents (Resident 1) reviewed for mechanical lift transfers. The failure to assess and develop a safe care plan for the use of a mechanical lift device, ensure staff training and competency in the use of the Named Mechanical Lift system, utilize the mechanical lift according to the manufacturers recommendations, and conduct post-fall resident assessment and investigation procedures resulted in harm to Resident 1 when they were dropped to the floor during an improper mechanical lift transfer, sustained cuts and bruising to their head and body, experienced pain, and created intense sense of fear for Resident 1 surrounding further use of the… […]