Humboldt County Memorial Hospital

In the surveyor’s words

From the most serious findings on record at Humboldt County Memorial Hospital, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF812Jan 4, 2024

  Based on observations and staff interviews the facility failed to cover food items when transported. The facility identified a census of 26 residents. Findings include: On 1/3/24 during the noon meal service, observed 5 room trays leave the serving kitchen after Staff A, Cook and Staff B, Dietary Aide assembled each tray. The following items were not covered on each room tray: 1. Resident #9- garden salad and pineapple upside down cake 2. Resident #12- garden salad and pineapple upside down cake 3. Resident #13- garden salad 4. Resident #5- garden salad and pineapple upside down cake 5. Resident #6- pineapple upside down cake. On 1/3/24 at 1:00 PM, Staff A, Cook acknowledged and verified all items on a room tray should be covered. […]

• No harm, potential for more than minimal, isolatedF550Feb 9, 2026

  Based on record review, staff and resident interview, the facility failed to ensure a resident's call light was in reach for 1 of 13 resident's reviewed (Resident #7). The facility reported a census of 25 residents.Findings include:According to the Minimum Data Set (MDS) assessment dated [DATE], Resident #7 scored 15 on the Brief Interview for Mental Status (BIMS) indicating no cognitive impairment. The resident depended on staff for toileting hygiene, rolling left and right, and transfers. The resident's diagnoses included chronic kidney disease, diabetes, and coronary artery disease.The Care Plan revised 9/7/21 identified Resident #7 at risk for falls. […]

• No harm, potential for more than minimal, isolatedF580Feb 9, 2026

  Based on clinical record review, staff interviews and policy review, the facility failed to notify the Physician and family/resident representative of a condition change for 1 of 13 residents reviewed (Resident #26). The facility reported a census of 25 residents.Findings include: The Minimum Data Set (MDS) for Resident #26 dated 11/3/25 assessment identified a Brief Interview for Mental Status (BIMS) score was a 5, indicating severe cognitive impairment. Resident #26's MDS included diagnoses of Alzheimer's, Non-Alzheimer's disease, gastroesophageal reflux disease, anxiety, and depression.The Care Plan revised on 8/8/25 documented staff to monitor, document, and report as needed any signs and symptoms of dysphagia (difficulty swallowing) which included pocketing, choking, coughing,… […]

• No harm, potential for more than minimal, isolatedF689Feb 9, 2026

  Based on clinical record reviews and staff interviews, the facility failed to provide adequate nursing supervision to prevent accident and injuries for 1 of 1 residents reviewed (Resident #19) for falls. The facility reported a census of 25 residents. Citation considered past noncompliance as the facility completed the following interventions prior to the surveyor entering the facility on February 4, 2026:Staff education provided on always utilizing the gait belt with resident transfers on 10/22/25.Staff education provided to Staff D, Certified Nursing Assistant, on the importance of utilizing a gait belt with the resident transfers on 10/23/25. […]

• No harm, potential for more than minimal, isolatedF880Feb 9, 2026

  Based on observations, clinical record review, staff interviews, and policy review, the facility failed to provide a safe and sanitary environment to help prevent the development and transmission of communicable diseases and infections for 1 of 1 resident reviewed (Resident #37) with an indwelling catheter. The facility reported a census of 25 residents.Findings include: Resident #3's Minimum Data Set (MDS) dated [DATE] assessment identified a Brief Interview for Mental Status (BIMS) score of 10, indicating moderately impaired cognition. The MDS identified Resident #3 required partial/moderate assistance with toileting hygiene. Resident #3's MDS included diagnoses of benign prostatic hyperplasia (BPH), neoplasm (tumor) of the bladder and overactive bladder. […]