Heritage Pointe Rehabilitation and Healthcare CTR

In the surveyor’s words

From the most serious findings on record at Heritage Pointe Rehabilitation and Healthcare CTR, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Nov 20, 2025

  Based on policy review, observation, and staff interview, it was determined that the facility failed to properly serve food and maintain sanitary conditions in the main kitchen. Findings include:Review of the facility policy entitled, Food: Preparation, last reviewed November 7, 2025, revealed that all staff were to practice proper hand hygiene and glove use. Dining Services staff were responsible for food preparation procedures and using serving utensils appropriately to prevent cross contamination.Observation of the tray line service on November 18, 2025, at 12:35 p.m., revealed the following:Dietary Employee 1 (DE 1) was observed obtaining pork chops and a quiche using only his gloved hands without serving utensils and placing them on resident's meal trays. […]

• No harm, potential for more than minimal, widespreadF812Dec 5, 2024

  Based on policy review, staff interview, and observation, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department. Findings include: Review of the facility's policy entitled, Labeling and Dating, dated [DATE], revealed that leftovers were to be labelled with the date that they were prepared and the use-by date. Prepared foods were to be discarded after seven days. Review of the facility's policy entitled, Staff Attire, dated [DATE], revealed that all staff with facial hair were to have it properly restrained. Observations during the tour of the dietary department on [DATE], at 10:12 a.m., revealed the following: In dry storage, there was food and paper debris on the floor under two sets of shelves storing food items. […]

• No harm, potential for more than minimal, widespreadF812Mar 5, 2021

  Based on observation and interview, it was determined that the facility failed to store food under sanitary conditions in the kitchen. Findings include: Observation of the kitchen on March 2, 2021, at 10:36 a.m., revealed one cucumber with a small area of a white substance on the surface and a container of cheese sauce dated February 20, 2020, in a reach in refrigerator. The Director of dining services confirmed the abnormal substance on the surface of the cucumber and reported leftover items should be stored for a period of seven days and then discarded. Observation of the dry storage area revealed an open bag of breadcrumbs, the contents were not transferred to an air tight container or sealed in the original bag. There was also an open bag of dried cranberries. […]

• No harm, potential for more than minimal, isolatedF580Mar 27, 2026

  Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to ensure that the responsible party was notified in a timely manner of the outcome of an investigation into an injury of unknown origin for one of five sampled residents. (Resident 1)Findings include: Review of facility policy entitled Abuse, Neglect, and Exploitation, last reviewed, November 7, 2025, revealed that the facility would implement policies and procedures preventing and prohibiting all types of abuse, neglect, misappropriation of resident property, and exploitation that achieved providing residents, representatives, and staff information on how and to whom they would report concerns, incidents and grievances without fear of retribution; and would provide… […]

• No harm, potential for more than minimal, isolatedF759Nov 20, 2025

  Based on observation, clinical record review, and staff interview, it was determined that the facility failed to maintain a medication error rate of less than five percent (%) for one of two nursing units observed during medication administration. (North unit)Findings include: Observation of medication administration on November 19, 2025, from 8:10 a.m. to 8:50 a.m., revealed 32 medication opportunities with two medication errors that resulted in a medication administration error rate of 6.25%. Clinical record review revealed that Resident 52 had diagnoses that included atrial fibrillation (fast heart rate), chronic kidney disease, and hypothyroidism. […]