Highlands Nursing and Rehabilitation

In the surveyor’s words

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

• Immediate jeopardy, isolatedF655Mar 23, 2024

  Based on interview, record review and review of the facility's policy, the facility failed to develop a baseline care plan for one (1) of three (3) residents sampled related to elopement (Resident #642). Upon admission, the facility assessed Resident #642 as a high risk for wandering/elopement. However, the facility failed to care plan the resident for his/her high risk for wandering/elopement. Resident #642 exited through the front door and left the faciity on [DATE]. Resident #642 returned to his/her home located eighty-five (85) miles away. Resident #642 did not return to the facility. […]

• Immediate jeopardy, isolatedF689Mar 23, 2024

  Based on observation, interview, record review, review of facility policy, and Internet Google Maps, the facility failed to ensure all residents were in a safe and supervised environment to prevent elopement for one (1) of three (3) residents sampled for elopement (Resident #642). The facility admitted Resident #642 on 01/05/2023 and he/she eloped from the facility on 01/07/2023 and did not return. The resident exited out the facility's front door when the receptionist, not knowing he/she was a resident, opened the door to let him/her out. Resident #642 was located 85 miles away from the facility. […]

• Immediate jeopardy, isolatedF656Feb 12, 2021

  Based on interview, record review and review of the facility's policies, it was determined the facility failed to have an effective system to ensure two (2) of twenty-seven (27) sampled resident's care plans were implemented, Resident #8 and Resident #25. Resident #8 was readmitted to the facility on [DATE] with an indwelling urinary catheter in place. Resident #8's care plan was revised to include the new placement of a catheter but there was no documented evidence to show that catheter care was provided between his readmission on [DATE] through [DATE]. […]

• Immediate jeopardy, isolatedF684Feb 12, 2021

  Based on interview, record review and review of the facility policies, it was determined that the facility failed to have an effective system to ensure two (2) of twenty-seven (27) sampled residents received quality of care and treatment, Resident #8 and Resident #25. Resident #8 had a history of blood clots and was receiving an anticoagulant medication. The facility failed to ensure staff monitored the resident after the anticoagulant medication was discontinued, on [DATE]. Resident #8 was sent to an acute care facility, on [DATE], with multiple diagnoses which included Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT). […]

• Immediate jeopardy, isolatedF690Feb 12, 2021

  Based on facility policy review, record review, observation, and interview it was determined the facility failed to have an effective system to ensure one (1) of twenty-seven (27) residents received care and services for an indwelling urinary catheter, Resident #8. Resident #8 returned to the facility after an acute care stay on [DATE] with an indwelling catheter in place. However, from [DATE] to [DATE] there was no documented evidence the facility performed care and services for Resident #8's indwelling catheter or obtained laboratory tests as ordered by the physician. Resident #8 was admitted to acute care, on [DATE], with multiple diagnoses, which included a Urinary Tract Infection (UTI) and Sepsis, requiring intravenous antibiotic therapy. Resident #8 expired at the hospital on [DATE]. […]