Medina Nursing Center

In the surveyor’s words

From the most serious findings on record at Medina Nursing Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Sep 19, 2025

  Based on observation, interview, and record review the facility failed to ensure the safety of a dependent resident who was left outside in the sun for two hours without water or a way to call for help. This applies to 1 of 3 residents (R1) reviewed for safety and supervision in the sample of 6. This failure resulted in R1 being transferred to an acute care hospital for treatment of heat exhaustion, sun burn, hypoxia, and altered mental status. The Immediate Jeopardy began on 9/14/25 when R1 was assisted outside in her reclining wheelchair and placed directly in the sun without staff supervision and monitoring in place for two hours. V2 (Assistant Administrator) was notified of the Immediate Jeopardy on 9/19/25 at 11:25 AM. […]

• Actual harm, isolatedF684May 26, 2026

  Based on interview and record review the facility failed to identify a resident's new, non-pressure wounds. The facility failed to perform weekly wound assessments on a resident's wounds. These failures resulted in R2 being hospitalized for cellulitis (bacterial skin infection) of his left foot after maggots were found in R2's left foot wounds. These failures apply to 1 of 3 residents (R2) reviewed for wounds in the sample of 6.The findings include:R2's admission records dated 1/2/26 showed R2 was admitted to the facility with diagnoses including cellulitis of his bilateral lower legs, peripheral vascular disease, lymphedema, obesity, and congestive heart failure. […]

• Actual harm, isolatedF689Dec 6, 2025

  Based on observation, interview, and record review the facility failed ensure the safety of a dependent resident by not preventing a burn for 1 of 3 residents (R1) reviewed for safety in the sample of 3. This failure resulted in R1 sustaining a 2nd degree burn to his left knee. The findings include:R1's face sheet showed he was admitted to the facility 8/15/25 with diagnoses to include dementia, metabolic encephalopathy, atherosclerotic heart disease, ischemic cardiomyopathy, chronic congestive heart failure, chronic obstructive pulmonary disease, benign prostatic hyperplasia with urinary tract symptoms. […]

• Actual harm, isolatedF689Mar 14, 2024

  Based on interview and record review, the facility failed to perform a safe mechanical lift transfer for 1 of 3 residents (R12) reviewed for safety/supervison in the sample of 15 . This failure resulted in R12 experiencing a fall from the mechanical lift and sustaining a hematoma. The findings include: R12's electronic face sheet printed on 3/13/24 showed R12 has diagnoses including but not limited to Alzheimer's disease, dementia with behaviors, congestive heart failure, acute respiratory failure with hypoxia, acute pulmonary edema, major depressive disorder, and repeated falls. R12's facility assessment dated [DATE] showed R12 has severe cognitive impairment and is dependent on staff for all transfers. […]

• Actual harm, isolatedF689Jan 16, 2024

  Based on interview and record review the facility failed to ensure a resident was supervised and assisted as needed by staff while ambulating which contributed to R1 falling in the facility and sustaining a right hip fracture. This failure applies to 1 of 3 residents (R1) reviewed for safety and supervision in the sample of 6. The findings include: The facility's Fall-Initial Documentation note dated 1/7/24 showed R1 fell while walking, by herself, in the dining room of the facility. The note showed R1's fall was witnessed by V7 Dietary Aide and V8 Nurse Manager. The note showed R1 was walking with a walker when she was trying to move her legs but legs would not move. Resident then lost her balance and fell on her right side. Upon examination, R1's right leg appeared shortened and rotated. […]