Helia Southbelt Healthcare

In the surveyor’s words

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

• Immediate jeopardy, isolatedF689Jun 4, 2026

  Based on interviews and record review, the facility failed to properly secure a resident's wheelchair in the transport van during transport for 1 (R2) of 3 residents reviewed for accidents in the sample of 16. This failure resulted in R2 falling from her wheelchair while the van was in motion, sustaining multiple serious injuries: a periprosthetic proximal femur fracture, intertrochanteric fracture of the left femur, distal fracture of the right femur, nasal fracture, and a scalp laceration. R2 required surgical fixation of the right femur (open reduction internal fixation) and suturing of the forehead laceration.An Immediate Jeopardy began on 4/24/26 when R2 was being transported to doctor's appointment in the facility van. […]

• Actual harm, isolatedF684Sep 25, 2025

  Based on observation, interview, and record review the facility failed to ensure a resident received treatment and care in accordance with professional standards of practice for hand contracture management and treatment for 1 of 1 resident (R34) reviewed for quality of care in the sample of 57. This failure resulted in R34 experiencing severe pain, infection, and a wound on her left hand. Findings Include: R34's face sheet, print date of 9/23/25, documented R34 has diagnoses including atherosclerotic heart disease, hypothyroidism, type 2 diabetes mellitus, hyperlipidemia, major depressive disorder, anxiety disorder, intermittent asthma, and muscle weakness. R34's MDS (Minimum Data Set), dated 7/4/25, documented R34 is moderately cognitively impaired. […]

• Actual harm, isolatedF600Aug 13, 2025

  Based on observation, record review, and interview, the facility failed to prevent resident to resident abuse for 1 of 6 residents (R3) reviewed for abuse in the sample of 8. This failure resulted in R3 having lacerations and bruising. Findings Include:On 8/13/25 at 1:00 PM, R3 was observed ambulating independently on the hallway he resides. R3 was wandering on the hallway, stopping at various doors but did not enter. R3 was alert to self only.R3's Face Sheet, undated, documents R3 has the following diagnoses: Dementia, Restless and Agitation, Unspecified Psychosis, Major Depressive Disorder, Generalized Anxiety Disorder, and Insomnia.R3's Minimum Data Set, MDS, dated [DATE], documents R3 has a BIMS (Brief Interview of Mental Status) score of 2, indicating R3 has severe cognitive… […]

• Actual harm, isolatedF760Apr 5, 2024

  Based on interview and record review the facility failed to make sure medications were provided and given for 1 of 3 residents, (R2) reviewed for significant medications in the sample of 18. This failure resulted in R2 missing, 9 doses of his Glaucoma medication, which is a significant medication error. Findings Include: R2's Minimum Data Set, (MDS), dated [DATE] documents, R2 is severely cognitively impaired. R2's Care Plan dated, 05/03/23, did not document anything about his Glaucoma, for bedside usage of Glaucoma medications. R2's Physician Order Sheet, (POS), dated 11/08/23, documents, Brimonidine/Timolol 0.2%-0.5% BID, (Twice Daily), may have drops at bedside, for resident to insert. […]

• Actual harm, isolatedF760Mar 14, 2024

  Based on interview and record review the Facility failed to ensure Physician Orders were being followed and residents were free from any significant medication errors for 1 of 6 residents (R2) reviewed for medication errors in the sample of 24. This failure resulted in R2 not receiving her medications and being hospitalized for six days with a diagnosis of urinary tract infection and urosepsis. Findings include: R2's Physician Order Sheet for February 2024 documents, a diagnosis of thyrotoxicosis; adrenocortical insufficiency; heart failure. R2's POS does not document, any loss of an adrenal gland. R2's POS with a start date of 2/26/2024 documents, hydrocortisone 10 milligrams (mg), once a day. […]