Oakview Medical Care Facility

In the surveyor’s words

From the most serious findings on record at Oakview Medical Care Facility, in the surveyor’s own words.

• Immediate jeopardy, patternF689Oct 29, 2021

  Based on observation, interview, and record review, the facility failed to monitor and maintain safe hot water temperatures at residents sinks (400 (Red) hall including R58, R42 and R38), resulting in an immediate jeopardy when temperatures in the residents rooms were found to be above 120 degrees with the potential for scalding of residents' skin. Immediate Jeopardy was identified: [DATE] at 2:40 PM. It began on [DATE]. The Administrator was verbally notified of the Immediate Jeopardy: [DATE] at 4:00 PM The Facility provided a written plan of removal via email: [DATE] at 8:17 AM Findings include: On [DATE] at 2:40 PM, the common hand sink, located in room 18, was observed to be at 122.2 degrees F, determined by a thermapen digital probe thermometer. […]

• Actual harm, isolatedF684Jul 7, 2021

  Based on interview and record review, the facility did not provide care in accordance with professional standards of practice when medications for nebulizer treatments listed on the discharge summary were not addressed for one Resident #1 of three residents reviewed for respiratory care. This deficient practice resulted in respiratory distress, with subsequent hospitalization . Findings include: According to the Nursing Admission Assessment, dated 3/26/21, Resident #1 was admitted to the facility on [DATE], with normal speech, cognition and was pleasant and cooperative. The document also revealed Resident #1 became short of breath (SOB) with exertion and had diminished lung sounds with a regular heart rhythm. […]

• Actual harm, isolatedF755Jul 7, 2021

  Based on interview and record review, the facility failed to provide a physician ordered respiratory nebulizer treatment, for one Resident (#1) of three residents reviewed for respiratory care. This deficient practice resulted in respiratory distress, with subsequent hospitalization . Findings include: According to the Nursing Admission Assessment, dated 3/26/21, Resident #1 was admitted to the facility on [DATE], with normal speech, cognition and was pleasant and cooperative. The document also revealed Resident #1 became short of breath (SOB) with exertion and had diminished lung sounds with a regular heart rhythm. […]

• Actual harm, isolatedF689Feb 26, 2021

  This citation refers to MI 043. Based on interview and record review, the facility failed to prevent a fall for 1 of 4 residents (Resident #6) reviewed for falls, resulting Resident #6 sustaining a fall with major injury. Findings include: A review of Resident #6's Admission Record, dated 2/26/21, revealed Resident #6 was an [AGE] year-old resident admitted to the facility on [DATE]. In addition, Resident 6's Admission Record revealed Resident #6 had multiple [DIAGNOSES REDACTED]. […]

• No harm, potential for more than minimal, widespreadF812Feb 13, 2025

  Based on observation, interview, and record review, failed to ensure 1) equipment was being maintained, 2) required information/reminders are being provided at hand sinks 3) maintain physical facilities in sanitary conditions and in good repair potentially effecting 69 residents that receive food/water from the facility. Findings include: The following observations were observed on 02/11/25 between 10:29 AM to 1:50 PM, during tour of the kitchen/facility with Directory of Dietary (DOD) A. Observation of the dish washing area revealed a large area of the flooring had low grout, resulting in a build-up of food residues/debris, standing water and grime between the floor tiles. […]