Longleaf Neuro-Medical Treatment Center

In the surveyor’s words

From the most serious findings on record at Longleaf Neuro-Medical Treatment Center, in the surveyor’s own words.

• Immediate jeopardy, patternF610Mar 14, 2024

  Based on record review and staff interviews the facility failed to protect residents from the accused staff during an investigation of staff to resident abuse. On 2/15/24 staff observed Nurse Aide (NA) #1 strike Resident #21 with a closed fist twice in the face and push him down on the floor. An abuse investigation was initiated on 2/15/24. On 2/16/24, during the abuse investigation, NA #1 arrived at the facility, clocked in at 6:56 AM and was given a resident care assignment. NA #1 clocked out at 10:56 AM. This deficient practice was for 1 of 3 residents (Resident #21) reviewed for abuse and had the high likelihood of serious injury/harm for other residents. […]

• Immediate jeopardy, patternF689Sep 9, 2022

  Based on observation, record review, resident, staff and Physician interviews the facility failed to safeguard a resident from entrapment when Resident #21's half side rail was in the up position, he fell out of bed, his right arm became caught between the side rail and the mattress, and he was unable to free himself. Resident #21 sustained 2 abrasions to his knee and was at high likelihood of suffering serious injury or death as a result of the entrapment. The facility also failed to follow the manufacturer's instructions for a mechanical lift when transferring Resident #8 out of bed resulting in the resident falling out of the lift face first to the floor. Resident #8 experienced pain and sustained soft tissue swelling, a scalp hematoma, and a laceration to the forehead. […]

• Immediate jeopardy, patternF835Sep 9, 2022

  Based on observations, record review resident staff, and Physicain interviews the facility failed to provide oversight to ensure effective systems were in place for ongoing monitoring after concerns were identified with side rails and mechanical lift transfers placing other residents at risk for entrapment with side rails and accidents involving mechanical lifts. In addition, Administration failed to act or revise measures implemented for the use of side rails when auditing revealed the system implemented was ineffective. Immediate Jeopardy for example #1 began on 8-16-22 when the facility failed to act and revise the ongoing monitoring of side rails and a resident was found entrapped in his half side rail. […]

• Immediate jeopardy, isolatedF600Mar 14, 2024

  Based on record review, observation, and interviews with police, psychologist, physician, resident, and staff, the facility failed to protect Resident #21 from physical abuse perpetrated by Nurse Aide (NA) #1. On [DATE] Resident #21 was attempting to leave a common area of the facility by lifting his walker up over his head to get past two residents who were seated. NA #1 prevented his exit by placing her hands on the walker to position it back on the floor. Resident #21 hit NA #1 and told her to shut up followed by the use of profanity. NA #1 then struck Resident #21 with a closed fist twice in the face and pushed him down to the floor. The resident sustained a small scratch on his face. He indicated the incident made him mad. […]

• Actual harm, isolatedF689May 14, 2026

  Based on record review and staff interview, the facility failed to provide care in a safe manner. During incontinence care a resident fell while standing and sustained a fracture of the left distal femoral shaft (break in the lower portion of the thighbone just above the knee) with malalignment. This practice occurred for 1 of 3 residents reviewed for supervision to prevent accidents (Resident #1). Resident #1 was admitted to the facility on [DATE] with diagnoses that included major neurocognitive disorder due to vascular disease with behavioral disturbance and disorganized schizophrenia. […]