Majestic Care of Deming Park

In the surveyor’s words

From the most serious findings on record at Majestic Care of Deming Park, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Nov 3, 2025

  Based on interview and record review, the facility failed to protect the resident's right to be free from neglect, when staff failed to visualize a confused resident during their shift resulting in the resident eloping from the facility for 1 of 3 residents reviewed for neglect (Resident B). The immediate jeopardy began on 10/11/25 when the facility failed to protect the resident's right to be free from neglect when a resident with a traumatic brain injury and at risk of elopement was able to exit the facility sometime after 9:30 p.m., on 10/11/25, or early morning, on 10/12/25, despite wearing a WanderGuard (a type of wander management system used in senior living communities and healthcare facilities to prevent residents at risk of wandering from leaving the premises unsupervised)… […]

• Immediate jeopardy, isolatedF689Nov 3, 2025

  Based on record reviews, interviews, and observation, the facility failed to supervise and prevent a confused resident at risk of elopement from eloping from the facility sometime after 9:30 pm on 10/11/25 into the early morning of 10/12/25 (Resident B). A resident with a traumatic brain injury and at risk of elopement was able to exit the facility sometime after 9:30 p.m. on 10/11/25 or early morning on 10/12/25 despite wearing a WanderGuard bracelet (a type of wander management system used in senior living communities and healthcare and healthcare facilities to prevent residents at risk of wandering from leaving the premises unsupervised). The facility alarm system failed to alert staff of the resident exiting with a WanderGuard. […]

• Immediate jeopardy, isolatedF690Mar 8, 2024

  Based on interview and record review, the facility failed to assess and treat a resident's urinary catheter and follow-up on continued hematuria resulting in immediate jeopardy when the resident with a history of UTI and septic shock did not have a follow-up with a Urologist for continued hematuria and blood clots, had a change in condition with his urinary catheter, and was sent to the hospital several hours later in septic shock and respiratory failure for 1 of 5 residents reviewed for change in condition (Resident B). The immediate jeopardy began on [DATE] when Resident B, with a history of urinary catheter, severe sepsis with septic shock, and urinary tract infection (UTI) on [DATE], had a distended abdomen and low urine output in the foley drain bag on [DATE] at 10:19 p.m. […]

• No harm, potential for more than minimal, widespreadF812Jun 25, 2025

  Based on observation, interview, and record review, the facility failed to ensure a sanitary area for handwashing, the dishwasher functionality was effectively checked, foods were covered when stored, and foods were discarded once past the best if used by date. This deficient practice had the potential to effect 61 of 61 residents who received food from the kitchen. Findings include: During a kitchen observation, on 6/19/25 at 10:05 a.m., with the Culinary Manager, the handwashing sink had a trash cans nearby, but the trash can had a lid affixed to the top with no hands free way to open the trash can. The Culinary Manager indicated the dishwasher sanitized dishes through chemical sanitation. […]

• No harm, potential for more than minimal, widespreadF882Jun 25, 2025

  Based on record review and interview, the facility failed to ensure a dedicated Infection Preventionist (IP-a healthcare professional who specializes in preventing the spread of infections within healthcare facilities) was designated to oversee the facility's Infection Prevention program. Findings include: During the entrance conference, on 6/19/25 at 10:00 a.m., Registered Nurse (RN) 11's certification of completion of the IP curriculum was provided. The RN was indicated as the dedicated IP for the facility. […]