Henderson Nursing and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Henderson Nursing and Rehabilitation Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF761Apr 30, 2021

  Based on observation, interview, and review of the facility's policy, it was determined the facility failed to ensure all residents' drugs and biologicals which were expired were removed from all medication administration areas in order to prevent possible administration to residents. The findings include: Review of the facility policy titled, Administering Oral Medications Level III Purpose, undated, revealed, staff were to check the expiration dates on all residents' medications and return any expired medications to the Pharmacy. Observation 04/29/2021 at 10:10 AM, of the refrigerator located in the facility's Medication Prep Room, revealed one (1) bottle of [MEDICATION(S)] Suspension 20 milligrams/milliliter (mg/ML) with an expiration date of 03/21/2021. […]

• No harm, potential for more than minimal, patternF812Apr 30, 2021

  The facility failed to prepare, distribute and serve food in accordance with professional standards for food service safety as related to the kitchen floor not being clean. Review of facility policy titled, Environment, revision date of 09/2017, revealed All food preparation areas, food service areas, and dining areas will be maintained in a clean and sanitary condition. The Dining Services Director will ensure that the kitchen is maintained in a clean and sanitary manner, including floors, walls, ceilings, lighting and ventilation. […]

• No harm, potential for more than minimal, isolatedF880Jun 5, 2026

  Based on observation, interview, and review of the facility's policies, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections for 1 of 6 sampled residents, Resident (R)79. The findings include: Review of the facility's policy titled, Medication Administration, revised 03/2026, revealed the purpose is for medications to be administered by licensed staff who will follow the established facility infection control procedures. […]

• No harm, potential for more than minimal, isolatedF656May 16, 2025

  Based on observation, interview, record review, and review of facility policy, the facility failed to implement a comprehensive person centered care plan for 2 of 23 sampled residents, (Resident (R)50, and R42). 1. Review of R50's comprehensive person centered care plan revealed the resident was to wear left and right hand and knee splints daily for six days. However, observation on 05/13/2025 at 12:03 PM and 2:18 PM, on 05/14/2025 at 9:10 AM, 11:23 AM , on 05/15/2025 at 9:20 AM and 11:30 AM of R50, revealed two hand splints lying on the resident's bedside table; and observation on 05/16/2025 at 10:18 AM revealed the hand splints were located in R50's closet. […]

• No harm, potential for more than minimal, isolatedF688May 16, 2025

  Based on observation, interview, record review and review of facility policy, the facility failed to ensure residents with limited range of motion received appropriate treatment and services to prevent further decrease in range of motion (ROM) for 1 of 23 sampled residents, (Resident (R)50). R50 was care planned with interventions to have left and right wrist and knee splints daily for six days. However, observation revealed two hand splints lying on R50's bedside table or located in the resident's closet. Additionally, observation revealed R50 did not have knee splints on while in bed and the resident's knees were drawn up to her chest. […]