Optalis Health and Rehabilitation at St. Francis

In the surveyor’s words

From the most serious findings on record at Optalis Health and Rehabilitation at St. Francis, in the surveyor’s own words.

• Immediate jeopardy, isolatedF684Jun 9, 2026

  This citation pertains to Intake Number 3027112.Based on interview and record review, the facility failed to ensure physician orders were followed for the timely testing and reporting results of residents' blood tests for three residents (#s 101, 106 and 107) of four residents reviewed for anticoagulant therapy (prevents blood from clotting) resulting in delays in evaluation and treatment for R101, R106 and R107 and the death of R101.Findings Include: A record review revealed Resident #101 who was receiving anticoagulant therapy did not receive the ordered timely testing and reporting of test results since admission into the facility. […]

• Immediate jeopardy, isolatedF678Oct 20, 2022

  This Citation pertains to Intake Number MI 365. Based on observation, interview and record review, the facility is placed in Immediate Jeopardy for its failure to (1.) use an Automated External Defibrillator (AED) and provide Cardiopulmonary Resuscitation (CPR) during a [CONDITION(S)] event for one resident (Resident #116) in violation of facility CPR Policy and the Basic Life Support (BLS) Standards of Care. (2.) Accurately document Cardiopulmonary Resuscitation efforts for two residents (Resident #116 and Resident #268) who expired at the facility. This deficient practice places all residents, who are designated as a Full Code and who suffer [CONDITION(S)] or are found unresponsive, at risk for serious harm and/or death. […]

• Actual harm, isolatedF684Jul 17, 2025

  This citation pertains to Intake #1230868.Based on observation, interview and record review, the facility failed to 1) Ensure that nursing staff gave appropriate care for failure, 2) Ensure that nursing staff completed a respiratory assessment during a respiratory crisis, and 3) Ensure that nursing staff followed facility nursing care plan for 1 resident (Resident #105) of 3 residents reviewed for nursing care, resulting in pulmonary edema, HH (excessively high) CO2 (Carbon Dioxide-lab) blood level, hypoxia, pneumonia, acute respiratory distress, hospitalization, respiratory failure with the high likelihood of death. […]

• Actual harm, isolatedF686Jan 23, 2025

  Based on observation, interview and record review, the facility failed to prevent a Stage III coccyx pressure ulcer from developing for 1 resident (Resident #76), and failed to implement meaningful and planned interventions for 1 resident (Resident #332), of 2 residents reviewed for pressure ulcers, resulting in a Stage III infected pressure ulcer, IV antibiotic usage, and hospitalization with the potential for delayed healing of pressure ulcers. Findings Include: Review of hospital records dated 1/22/25, stated The patient had Covid and pneumonia in December (2024) and was admitted from 12/7/24 to 12/26/24 and has been in rehabilitation (living at the facility) until today. […]

• Actual harm, isolatedF686Sep 18, 2024

  Based on observation, interview and record review, the facility failed to prevent and document the occurrence of a skin abrasion and Deep Tissue Injury (DTI) for one resident (Resident #1) and the development of pressure ulcers for one resident (Resident #2), resulting in Resident #1 to be found with an abrasion to the left lateral hip and right heel deep tissue injury and Resident #2 developing a pressure ulcer to the left heel as a deep tissue injury and increased to a Stage III pressure ulcer and, also, the left foot 5th toe pressure ulcer to develop and increase in size to a Stage II pressure ulcer, resulting in skin breakdown, pain, the likelihood for infection and diminished overall health and wellbeing. […]