Marywood Heights

In the surveyor’s words

From the most serious findings on record at Marywood Heights, in the surveyor’s own words.

• Actual harm, isolatedF600Mar 26, 2026

  Based on a review of clinical records, the facility's abuse prohibition policy, facility investigative documentation, and staff interviews, it was determined the facility failed to ensure that a resident was free from neglect by not providing care with the required assistance of two staff members and the use of a mechanical lift as planned to ensure safety and prevent major injuries. As a result, the resident sustained a fracture of the clavicle and a fracture of the first rib, representing actual harm for one resident (Resident 65) out of 20 residents sampled.Findings include: A review of a facility policy titled Investigation of Allegations of any Abuse Type last reviewed by the facility on January 3, 2026, revealed it is the facility's policy to provide protection for the health,… […]

• Actual harm, isolatedF689Jul 25, 2024

  Based on a review of clinical records and select investigation reports and staff interviews, it was determined that the facility failed to provide necessary supervision, and implement effective individualized safety measures for a resident with known unsafe behaviors to prevent multiple falls for one resident (Resident 13) and a serious burn, to one resident (Resident 27) out of 19 residents sampled. Findings include: A review of Resident 27's clinical record revealed that the resident was admitted to the facility April 14, 2023, with diagnoses to include hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left dominant side. (Hemiparesis, also called unilateral paresis, is the weakness of one entire side of the body. […]

• Actual harm, isolatedF600Jan 31, 2024

  Based on a review of the facility's abuse prohibition policy, select investigative reports and clinical records, and interview with staff it was determined that the facility neglected to provide the care and services necessary to avoid physical harm and maintain physical health for one resident out of five residents sampled (Resident 2). Findings include: A review of the facility's Resident Abuse policy, last revised January 2023, revealed that the facility will provide each resident with the highest practicable physical, mental, and psychological services to meet their individual needs and to promote or maintain the resident at their highest level of well-being. This includes the protection of Resident's Rights. […]

• Actual harm, isolatedF689Jan 12, 2022

  Based on a review of select facility policy, clinical records and select incident reports, and staff interview it was determined that the facility failed to provide necessary staff supervision and consistently implement individualized effective safety interventions to prevent a fall resulting in serious injuries, multiple fractured ribs, fractured thoracic spine, and laceration to left forehead, for one of five residents reviewed (Resident 4) Findings include: A review of facility policy entitled: Fall Management Policy and Procedure indicates the Fall's Management Program's goal is to prevent/reduce falls, reduce injury and ultimately improve the quality of life for our residents and enhance the resident's sense of security and safe environment. […]

• No harm, potential for more than minimal, patternF757Mar 26, 2026

  Based on review of clinical records, facility policy, and staff interview, it was determined the facility failed to ensure residents were free from unnecessary antibiotic medications for two of 20 residents reviewed (Residents 2 and 50). Findings include: A review of the facility policy titled Antibiotic Stewardship, last reviewed January 3, 2026, revealed appropriate indications for antibiotic use include meeting minimum clinical criteria for active infection utilizing McGeer Criteria (standardized clinical criteria used in long-term care to determine whether sufficient signs and symptoms are present to support diagnosis of infection and initiation of antibiotic therapy). […]