Oakmont Healthcare and Rehabilitation Center of Ka

In the surveyor’s words

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

• Immediate jeopardy, isolatedF689Oct 6, 2025

  Based on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 of 5 (Resident #1) residents reviewed for accidents and supervision. The facility failed to ensure that CNA B provided the necessary care and supervision to Resident #1 by ensuring CNA B did not sleep when providing 1:1 supervision to Resident #1 who has a history of falls with injury, including a recent subdural hematoma, CT scan done on 9/12/2025 showed the worsening as indicative by the findings as it noted significant interval change developed of hemorrhage since prior examination, there is a mixed density left subdural hematoma overlying the left cerebral convexity measuring up to 1.0 cm in thickness increased in… […]

• No harm, potential for more than minimal, widespreadF814Nov 15, 2024

  Based on observation, interview, and record review the facility failed to dispose of garbage and refuse properly for 1 of 2 dumpster reviewed for food and nutrition services. -The facility failed to ensure the dumpster door was closed at all times when no one was dumping garbage. This failure could place residents at risk of infection from improperly disposed garbage. Findings include: Observation on 11-12-24 at 8:45 am, revealed the facility's dumpster area, which was in the lot behind the dietary department had a commercial -size dumpster 3/4 full of garbage and the dumpster door was open. […]

• No harm, potential for more than minimal, widespreadF755Aug 11, 2022

  Based on observation, interview, and record review the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of 17 of 24 residents (Resident #3,# 7, #9, #10, #16, #18, #21, #39, #42, #51, #59, #63, #65, #74, #75, #336) and establish a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation for 1 of 4 medication carts (West Back CMA Medication Cart) reviewed for pharmacy services in that: - Resident #21's ordered Insulin was not available for administration, resulting in the resident receiving insulin over 5 hours after his meal was completed and a blood sugar of 460. […]

• No harm, potential for more than minimal, patternF550Feb 26, 2026

  Based on observation, interview and record review, the facility failed to ensure residents have a right to a dignified existence and treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 3 (Resident #41) of 18 residents reviewed for dignity.-RN Z was providing Resident #41's bolus feeding with the door open and blinds opened on 02/25/2026.- RN Z did not provide Resident #67 privacy during insulin administration on 02/25/26.-LVN AF did not provide privacy during medication administration via G Tube to Resident #30 on 2/24/26These deficient practices could lead to psychosocial harm due to feelings of low self-esteem and/or embarrassment regardless of resident… […]

• No harm, potential for more than minimal, patternF641Feb 26, 2026

  Based on observation, interviews, and record reviews, the facility failed to ensure the assessment accurately reflected the residents' status for 2 of 18 residents (CR #75 and Resident #60) whose assessments were reviewed, in that:-CR#75's behavior was not reflected on her initial MDS dated [DATE]. -Resident #60's fall on 10/15/2026 was not documented in her most recent quarterly MDS assessment on 11/29/2026.These failures could place residents at-risk of not receiving the care and services to prevent aggressive behavior or injury due to inaccurate assessments. #75 Record review of CR#75's clinical records dated 2/24/2026 revealed she was a 76-year female who was admitted to the facility on [DATE]. […]