Moran Nursing and Rehabilitation Center

In the surveyor’s words

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

• Actual harm, isolatedF578Nov 19, 2021

  Based on record review and staff interview, the facility failed to have a process in place to: 1) ensure that the most current Maryland Medical Order for Life-Sustaining Treatment (MOLST) form was placed in the residents' medical record. This was evident for 1 of 3 residents (Resident #1) reviewed for MOLST. The facility's failure resulted in harm to Resident #1 whose most current MOLST orders had indicated that Cardiopulmonary Resuscitation (CPR) not be performed in the event of [CONDITION(S)]. The failure of staff to follow the most current MOLST order form resulted in CPR being performed on the resident against the resident's wishes by facility staff, Emergency Medical Services (EMS), and hospital staff. […]

• No harm, potential for more than minimal, widespreadF880May 15, 2026

  Based on interviews, record reviews, and observations, it was determined that the facility failed to follow guidance from the Maryland Department of Health (MDH) and the facility's corrective action plan to prevent the risk of exposure to Legionella and failed to ensure infection control practices were implemented to minimize the potential spread of pathogens, including maintaining a designated handwashing sink, appropriate use of personal protective equipment (PPE), and proper cleaning of equipment. […]

• No harm, potential for more than minimal, widespreadF725Mar 11, 2025

  Based on record reviews and interviews it was determined the facility staff failed to ensure that licensed nurse coverage was present the entire night shift on 2/21/25. This was evident for 1 (#MD00214955) of 12 complaints reviewed during the survey. The findings include: During an interview on 3/5/25 at 2:26 PM, Resident #2 indicated to a surveyor that s/he felt unsafe. When asked to explain, s/he reported that agency staff who worked overnight 2 weekends ago left the building unattended, to get food. The resident added that no medications were given that evening. s/he was uncertain of the credentials of the staff involved. […]

• No harm, potential for more than minimal, patternF812May 15, 2026

  Based on observation, and interview with facility staff, it was determined that the facility failed to maintain food service equipment in a manner that ensures sanitary food service operations to prevent possible foodborne illness. This was evident during the kitchen tour of the annual survey. The findings include:A food-contact surface refers to any surface of equipment and utensils that typically comes into contact with food; or from which food may drain, drip, or splash onto food; or a surface that is usually in contact with food. […]

• No harm, potential for more than minimal, patternF609Mar 11, 2025

  Based on records review and interviews, it was determined that the facility failed to ensure allegations of abuse were reported within the mandated time frame. This was evident for 3 (Resident #38, #25, #64) of 6 residents reviewed for abuse. The findings include: 1.)On 3/06/25 at 11:56 AM a review of the facility reported incident (FRI) #MD00214156 was conducted. The report described an allegation that a Geriatric Nursing Assistant (GNA #3) was observed to have forcefully pushed Resident #25 into his/her wheelchair. […]