Laurel Lakes Rehabilitation and Wellness Center

In the surveyor’s words

From the most serious findings on record at Laurel Lakes Rehabilitation and Wellness Center, in the surveyor’s own words.

• Immediate jeopardy, patternF684Oct 18, 2024

  Based on clinical record review, hospital record review, and staff interviews, it was determined that the facility failed to ensure care and services were provided after a change in condition for one of 20 residents reviewed (Resident 1). This failure resulted in continued decline, which required hospitalization for septic shock (a widespread infection causing organ failure and dangerously low blood pressure) and death. This failure placed an additional 10 out of 20 residents reviewed who were identified as having a change in condition in an immediate jeopardy situation (Residents 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11). […]

• Immediate jeopardy, isolatedF689Jul 14, 2023

  Based on review of the clinical record, facility documentation review, review of policy and procedure, and staff interviews, it was determined that the facility displayed past non-compliance by failure to implement appropriate monitoring, supervision, and safety measures to prevent unsafe wandering of a resident (Resident 1) to an unsupervised area of the facility. This failure resulted in harm to the resident who was found unresponsive, had an external body temperature of 106 degrees Fahrenheit (F) and transfer to the hospital where she was intubated (tube inserted into the airway) and placed on a ventilator (a machine that helps someone breathe when they are unable to do so on their own). This failure placed Resident 1 in an Immediate Jeopardy situation. […]

• Actual harm, isolatedF755Jan 13, 2026

  Based on facility policy review, clinical record review, review of facility documentation, and staff interviews, it was determined that the facility displayed past non-compliance in its failure to provide pharmaceutical services to meet the needs of each resident for three of seven residents reviewed (Resident 1, 4, and 7), which resulted in actual harm as evidenced by a right elbow fracture and laceration for one of seven residents reviewed (Resident 1).Findings Include:Review of facility policy, titled Pharmscript Provider Pharmacy Requirements, last revised August 2020, read, in part, Procedures: 4. f. Providing routine and timely pharmacy service as contracted, as well as emergency pharmacy service 24 hours per day, seven days per week. […]

• Actual harm, isolatedF806Jul 14, 2022

  Based on facility policy review, review of clinical records and incident reports, as well as staff interviews, it was determined that the facility failed to ensure that residents were not served foods they were allergic to, which resulted in harm with an allergic reaction, requiring Benadryl (allergy medication), epinephrine (an injection used to treat life-threatening allergic reactions), and transfer to the hospital for difficulty breathing and a swollen external throat and tongue, for one of six residents reviewed (Resident 6). […]

• No harm, potential for more than minimal, patternF684May 20, 2026

  Based on clinical record review and staff interviews, it was determined that the facility failed to ensure care and services were provided in accordance with professional standards of practice that meet each resident's physical, mental, and psychosocial needs for three of 33 residents reviewed (Residents 5, 13, and 135).Findings include: Review of Resident 5's clinical revealed diagnoses that included diabetes mellitus (disease that occurs when your blood glucose, also called blood sugar, is too high) and dementia (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning). […]