Meadow Park Rehabilitation and Healthcare Center

In the surveyor’s words

From the most serious findings on record at Meadow Park Rehabilitation and Healthcare Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jun 18, 2025

  Based on record review, interviews and observations, it was determined that the facility staff failed to adequately monitor a cognitively impaired resident who had exit seeking behaviors. This was found to be evident for 1 (#217) out of 2 residents reviewed for exit seeking behaviors during the recertification survey. This deficient practice was determined to be an Immediate Jeopardy past non-compliance after the investigation was completed. The findings include: A review of Resident #217 electronic medical record (EMR) on 06/11/25 revealed on 11/11/24 Resident #217 left their room located on the first floor and went to the front desk and attempted to leave the facility. […]

• Immediate jeopardy, isolatedF689Jun 23, 2022

  Based on observations; the review of medical records, administrative reports, and other pertinent documentation; and interviews with facility staff, it was determined the facility failed to prevent Resident #33 from exiting the building unattended on 6/7/22; failed to develop and implement timely interventions to address Resident #93's exit-seeking behavior, and failed to ensure the facility's exterior doors were secured, alarmed, and functioning properly. The deficient practice was evident for 2 of 4 residents reviewed for elopement during the survey; however, the facility's failures had the potential to impact 4 of 4 residents identified as at risk for wandering or elopement. […]

• Immediate jeopardy, isolatedF600Nov 12, 2021

  Based on the review of medical records and pertinent documentation, interviews with facility staff, a resident's family member, and third-party service providers, it was determined that the facility failed to provide and implement a revised plan of care to meet a resident's needs when the resident experienced seizures starting on 10/25/21 until the resident was sent to the hospital by Emergency Management Services (EMS) on 10/26/21 for [CONDITION(S)] management. The facility failed to: 1) Administer [MEDICATION(S)] to Resident (#1) as ordered by the Nurse Practitioner during an emergency medical situation on 10/25/21; 2) Monitor and notify the physician of a resident's worsening condition; and 3) Observe a hospice resident's wishes for life sustaining treatment as documented on the… […]

• Actual harm, isolatedF689Aug 31, 2022

  Based on documentation review and interview, it was determined that the facility staff failed to protect a dependent resident from an accident with injury. This was evident for 2 of 3 (#33, #27) residents reviewed for accidents and caused harm to Resident #33 and Resident #27. The findings include: 1) On 8/26/22 at 7:45 AM review of Resident #33's medical record revealed Resident #33 was admitted to the facility in April 2022 with diagnoses that included but were not limited to cerebral infarction, [CONDITION(S)], abnormal bleeding and morbid (severe) obesity. A 7/30/22 physician's progress note documented, mobility and ADL (activities of daily living) impairment, weakness and debility secondary to multiple complex comorbidities. […]

• Actual harm, isolatedF600Mar 24, 2021

  Based on medical record review, observation of facility video surveillance and interview, the facility staff failed to prevent a resident from being abused (Resident #34). This was evident for 1 out of 36 residents reviewed during a complaint survey. This incident resulted in actual physical harm (pain) to the resident. Due to the facility's corrective measures following the incident, this is being cited as past non-compliance with a compliance date of 3/12/21. The findings include: On 3/15/21 a review of facility reported incident MD 534 revealed the facility submitted a report on 3/4/21 to OHCQ (Office of Health Care Quality) that on 3/4/21 Resident #34 reported he/she was physically abused by LPN #1. […]