Larkin Chase Center

In the surveyor’s words

From the most serious findings on record at Larkin Chase Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF580Apr 14, 2026

  Based on interview, record review, and facility policy review, the facility failed to promptly notify the provider of a critical and abnormal laboratory test values for 1 (Resident #7) of 3 sampled residents reviewed for a change in condition. On [DATE], Resident #7 experienced a change in condition and a nurse practitioner (NP) ordered STAT (a Latin word, statim, which meant immediately or without delay) laboratory tests to rule out pneumonia and assess for other possible underlying causes of the resident's change in condition. The blood specimen was collected for the laboratory tests, which revealed the resident had a high critical sodium level of 161 millimoles per liter (mmol/L). […]

• Immediate jeopardy, isolatedF684Apr 14, 2026

  Based on interview, record review, and facility policy review, the facility failed to ensure a STAT (a Latin word, statim, which meant immediately or without delay) chest x-ray was completed as ordered and timely provider notification of a critical and abnormal laboratory test values for 1 (Resident #7) of 3 sampled residents reviewed for a change in condition. On [DATE], Resident #7 experienced a change in condition and a nurse practitioner (NP) ordered a STAT chest x-ray and STAT laboratory tests to rule out pneumonia and assess for other possible underlying causes of the resident's change in condition. The STAT chest x-ray was not completed on [DATE]. […]

• No harm, potential for more than minimal, patternF656Jul 6, 2026

  Based on observation, interview and record review, it was determined that the facility failed to develop and implement resident-centered care plans for residents' urinary catheters and activities. This was evident for 4 (#10, #71, #3 , and #20) out of 32 residents reviewed during an annual survey. The findings include: A Care Plan is used in nursing facilities to summarize a resident's health conditions and care needs. It is used to ensure resident's needs are met and consistent care is provided to the resident based on those needs. 1. During a review of medical records for Resident #10 on 7/01/2026 at 12:09 PM it was discovered that the Resident's care plan included Resident requires indwelling catheter that was initiated on 4/27/2026. […]

• No harm, potential for more than minimal, patternF686Apr 14, 2026

  Based on interview, record review, and facility policy review, the facility failed to ensure there was an order to perform wound care when Resident #6 was identified to have an in-house acquired Stage 2 pressure ulcer. The facility further failed to ensure an order to perform wound care was transcribed and implemented for Resident #9's in-house acquired Stage 3 pressure ulcer; notify the Lead Registered Dietician of the resident's new pressure ulcer; and ensure there was not inconsistencies in how the resident's pressure ulcer was assessed and documented. […]

• No harm, potential for more than minimal, patternF812Jun 14, 2022

  Based on observations and interviews it was determined that the facility failed to ensure: 1) food items were stored properly and 2) staff practiced appropriate use of gloves. This deficient practice has the potential to affect all residents. The findings include: 1) During a tour conducted of the kitchen's refrigerator on [DATE] at 11:50 AM, the surveyors, the District Dietary Manager # 6 and District Dietary Manager # 7 observed 1 opened and undated box of rice, 1 jar of Peanut Butter opened and undated, 1 container of ground turmeric opened and undated, 1 bag of Parmesan cheese opened and undated, and 1 bottle of Kikkoman Soy Sauce that expired on [DATE]. […]