Hibbard Skilled Nursing & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Hibbard Skilled Nursing & Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF600Mar 22, 2023

  Based on record reviews, interviews, and facility policy, the facility failed to ensure a resident was free from physical and psychosocial harm which caused the resident to be afraid, angered, and embarrassed (Resident #1). In addition, the facility failed to ensure that a resident was free from physical and verbal abuse which caused the resident to have undue anxiety (Resident #2) for 2 of 2 facility incident reports reviewed. Findings: Review of facility policy titled Resident Abuse Prevention Policy and Procedure dated February 2022 states It is the policy of this facility to prevent abuse, neglect, and exploitation of residents living at this facility . […]

• Actual harm, isolatedF697Sep 20, 2022

  Based on record review, review of the facility's Pain Assessment Management Policy and Procedure, and interviews it was determined that the facility failed to put pain relieving interventions in place for 1 of 1 resident reviewed for pain management (Resident #1). Due to this facility's failure, the resident experienced consistent, unrelieved pain for four consecutive days in August 2022 and in September 2022. Finding: On 9/20/22, a review of Resident #1's clinical record was done. The resident was diagnosed with Dementia, stroke with residual deficits, legally blind, Stage II pressure ulcer on the coccyx, eschar to left heel, [CONDITION(S)]-Stage 4, and other co-morbidities. […]

• Actual harm, isolatedF689Jan 20, 2021

  Based on a review of the Nursing Facility Reportable Incident Form submitted to the Division of Licensing and Certification on 1/12/2021, the facility's internal investigation, dated 1/14/ , facility policy, and interviews, the facility failed to ensure a resident's safety in the area of transfers by not using appropriate lifting technique while transferring a resident with a hoyer lift, resulting in the resident sustaining avoidable injuries requiring hospitalization for 1 of 13 residents who requiring mechanical lift transfers (#1). […]

• No harm, potential for more than minimal, patternF578Jun 5, 2025

  Based on facility policy review, record reviews, and interview, the facility failed to ensure that the resident and/or resident representative received assistance/follow up assistance to complete the written information provided concerning the right to accept or refuse medical or surgical treatment and/or formulate an advanced directive, or appoint a surrogate, for 5 of 7 residents reviewed for advanced directives. (Resident #21 [R21], R24, R42 R72, R75). Findings: Review of facility policy Advanced Directives dated 3/25, Page 3 of 5, Section: If the Resident Does not have an Advanced Directive states if the resident or representative indicates that he or she has not established advanced directives, the facility staff will offer assistance in establishing advanced directives. […]

• No harm, potential for more than minimal, patternF644Jun 5, 2025

  Based on record review and interview, the facility failed to ensure that the State mental health authority for Pre-admission Screening and Resident Review (PASRR) was notified after a resident was newly diagnosed and/or experienced symptoms related to a mental disorder or trauma event to determine if a change in level of service was required, or incorporate the recommendations from a PASRR level II determination into a resident's assessment and care planning for 2 of 5 sampled residents reviewed for PASRR [Resident #30 (R30), R52]. Findings: 1. On 6/3/25, R30's clinical record was reviewed. […]