Memorial Nursing and Rehabilitation Center

In the surveyor’s words

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

• No harm, potential for more than minimal, isolatedF656Aug 13, 2026

  Based on observation, interview, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that meets professional standards of quality and that included measurable objectives and time frames for 3 of 16 (Residents #20, 29, and 31) residents reviewed for care plans.The facility failed to ensure Resident #20's daily use of compression socks had been included in the care- plan. There was no documentation in the care plan of measurable objectives, interventions, or timeframes for how staff would meet this need.The facility failed to ensure Resident #29 and #31's DNR status was included in the resident's care plan.These failures to accurately develop and implement a care plan could result in staff not being aware of critical… […]

• No harm, potential for more than minimal, isolatedF684Aug 13, 2026

  Based on observation, interview, and record review, the facility failed to ensure the residents received treatment and care in accordance with professional standards of practice for 1 of 16 residents (Resident # 20) reviewed for quality of care. The facility failed to follow physician orders and did not apply Compression socks as ordered for Resident # 20. This failure could place residents at risk of staff not being aware of needed care to maintain optimum health and placing them at risk for injury and/or deterioration in their condition. Findings included: Record review of Resident # 20 's face sheet printed 08/12/2026 revealed an [AGE] year-old female. […]

• No harm, potential for more than minimal, isolatedF578Jun 26, 2025

  Based on observation, interview, and record review, the facility failed to ensure all residents had the right to formulate an advanced directive for 2 (Resident #1 and #14) of 17 residents reviewed for advanced directives. Resident #1 had a DNR dated [DATE] (signed by the physician) in her record that was missing information in the Two Witness section. Resident #14 had a DNR dated [DATE] (signed by the physician) in her record that was missing information in the Two Witness section. The facility's failure could place residents a risk for not receiving healthcare as per their own or their legal representatives wishes. […]

• No harm, potential for more than minimal, isolatedF656Jun 26, 2025

  Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights and that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 (Resident #25) of 13 residents reviewed for comprehensive care plans. The facility failed to include Resident #25's antidepressant medication in her care plan dated 05/19/25. This failure could lead to residents not receiving needed care and/or receiving improper care/treatment. […]

• No harm, potential for more than minimal, isolatedF761May 15, 2024

  Based on observations, interviews, and record review, it was determined the facility failed to ensure drugs and biologicals were stored in locked compartments and labeled in accordance with currently accepted professional principles and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 2 of 2 medication carts (Medication Cart-Hall200/300 and Medication cart 400/500) reviewed for medication storage. The facility failed to ensure that there no lose pills, expired medications, and labels were legible. -2.5 pills found in medication cart for Hall 200/300 -2 bottles of expired medications found in medication cart for Hall 400/500. Findings included: Observation on 05/13/24 at 09:15 AM revealed Medication cart for 200 and 300 Hall. […]