Lake Haven Nursing and Rehab Center

In the surveyor’s words

From the most serious findings on record at Lake Haven Nursing and Rehab Center, in the surveyor’s own words.

• Immediate jeopardy, patternF600Feb 22, 2024

  Based on record review and interviews, the facility failed to protect resident's rights to eb free from medical neglect, failed to ensure individuals employed at the facility were licensed in accordance with applicable state laws to prevent medical neglect, when the facility failed to verify the identity, credentials, and licensure of an individual (Staff A) prior to employment as a registered nurse providing care and services for 19 shifts for 77 residents using a sample of 5 of 5 residents of the total 77 residents, Residents #6, #8, #4, #9, and #10. The failure of ensuring an individual is licensed as a registered nurse could result in the likelihood of harm and/or death to residents due to the lack of knowledge and education of medications and medication side effects. […]

• Immediate jeopardy, patternF607Feb 22, 2024

  Based on record review and interview, the facility failed to ensure policies and procedures were implemented to prohibit and prevent medical neglect when failing to ensure individuals employed at the facility were licensed in accordance with applicable state laws, when the facility failed to verify the identity, credentials, and licensure of an individual (Staff A) prior to employment as a registered nurse providing care and services for 19 shifts for 77 residents using a sample of 5 of 5 residents of the total 77 residents, Residents #6, #8, #4, #9, and #10. The failure of ensuring an individual is licensed as a registered nurse could result in the likelihood of harm and/or death to residents due to the lack of knowledge and education of medications and medication side effects. […]

• Immediate jeopardy, patternF835Feb 22, 2024

  Based on interview and record review, the facility administration failed to administer the facility in a manner to effectively and efficiently attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident when the facility administration failed to ensure an employee (Staff A) had a Level II Background Screening, failed to implement policies and procedures to verify the identity, credentials and licensure of an individual (Staff A) prior to employment as a licensed practical nurse providing care and services for 19 shifts for 77 residents using a sample of 5 of 5 residents of the total 77 residents, Residents #6, #8, #4, #9, and #10. […]

• Immediate jeopardy, isolatedF600Mar 29, 2024

  Based on observations, interviews and record reviews, the facility failed to protect the resident's right to be free from neglect by not ensuring one (#3) out of 14 residents at risk for elopement with a known history of exit seeking behaviors, and an expressed desire to leave the facility, was provided supervision and services to prevent elopement. The facility failed to ensure the secured unit exit door and door alarms were operating properly, failed to check the surroundings when the exit door alarmed, and failed to account for the whereabouts of all elopement risk residents on 3/6/2024. Resident #3 exited the secured unit of the facility via a maglock alarming dining room exit door on 3/6/24 at approximately 3:45 PM and was located at approximately 5:30 p.m. 0.8 miles away. […]

• Actual harm, isolatedF689Jun 11, 2026

  Based on interviews and record review, the facility failed to reevaluate and reassess interventions to prevent falls for one resident (#2) out of three reviewed. This resulted in Resident #2 sustaining a head laceration and transfer to acute setting for further evaluation. Findings included: Review of the facility's Incident Log showed Resident #2 had falls on 4/15/26 and 5/10/26. Review of Resident #2's progress noted showed:5/8/26 5:20 p.m. Patient found after unwitnessed fall with noted head injury. No acute distress noted. Upon assessment, light bleeding noted to head. Patient alert and responsive. Vital signs obtained and within normal limits (WNL). Provider notified of findings and new orders received for Computed Tomography (CT) scan. […]