Mountain View Center Genesis Healthcare

In the surveyor’s words

From the most serious findings on record at Mountain View Center Genesis Healthcare, in the surveyor’s own words.

• Actual harm, isolatedF689Apr 8, 2026

  Based on the interview and record review, the facility failed to implement safe mechanical lift procedures to prevent an avoidable accident for 1 of 5 sampled residents (Resident #1). The facility did not ensure that staff operating the mechanical lift were competent in the task per the facility policy. During transfer, Resident #1 sustained multiple skin tears and fractures to their body, including a fracture of the right femur (thigh bone) and a fracture to the left humerus (upper arm bone). This is a repeat violation previously cited in a partial survey dated 9/9/25. […]

• Actual harm, isolatedF726Apr 8, 2026

  Based on the interview and record review, the facility failed to ensure that 1 of 3 sampled Licensed Nursing Assistants possessed the specific competencies necessary to meet residents' needs, as identified through resident assessments and the plan of care. The facility did not ensure that staff operating the mechanical lift were competent in the task per the facility policy, which led to a resident sustaining multiple fractures and skin tears (Resident #1). This has the potential to affect all residents of the facility. Findings include:Based on the interview and record review, the facility failed to ensure that 1 of 3 sampled Licensed Nursing Assistants possessed the specific competencies necessary to meet residents' needs, as identified through resident assessments and the plan of care. […]

• Actual harm, isolatedF689Sep 9, 2025

  Based on interview and record review the facility failed to implement interventions to ensure residents were free of accidents for 1 of 3 residents (Resident #1). As a result, a resident suffered a fall which required hospitalization related to a fractured hip and pain management. Findings include: Per record review, Resident #1 has diagnoses that include irradiation of the pelvis, epilepsy, presence of an artificial eye, and normal pressure hydrocephalus (a neurologic condition characterized by an abnormal accumulation of cerebrospinal fluid in the brain). […]

• Actual harm, isolatedF684Apr 5, 2023

  Based on observation, interview, and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice related to proper wheelchair positioning and follow through on physical therapy recommendations for 1 resident (Resident #87) and failed to identify and provide needed care and services regarding bowel management to prevent rehospitalization for 1 Resident (Resident #58) in a sample of 31 Residents. Findings include: 1. Per record review of the facility January Bowel Record reveals that resident #58 had no documented bowel movements from 1/1 - 1/7/2023 and 1/23 - 1/27/2023. The Resident experienced untreated constipation resulting in a 15 day rehospitalization . […]

• No harm, potential for more than minimal, widespreadF761Jun 4, 2025

  Based on observation and interview, the facility failed to ensure resident medications were securely stored and expired medications and treatment materials were removed from possible use on all 4 resident units. Findings include: 1. An observation was conducted on the facility's Beechtree unit on 6/1/25 at 5:49 PM. An unattended medication cart was observed unlocked, with no facility staff present in the hallway where the medication cart was located. Per interview with a staff Registered Nurse at 5:51 PM, the medication cart contained physician prescribed medications for multiple residents and should remain locked at all times but was not. 2. […]