Page Rehabilitation and Healthcare Center

In the surveyor’s words

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

• Immediate jeopardy, isolatedF600Jan 10, 2025

  Based on record review, review of facility's policies and procedures, and staff interviews, the facility failed to protect residents' rights to be free from neglect by failing to re-evaluate Resident #999's elopement risk and prevent unsafe wandering and elopement with onset of paranoid behaviors such as distrust of staff and verbal expression of desire and intent to leave the facility. Resident #999 diagnoses included dementia and psychosis. The resident used a wheelchair for mobility and was ambulatory with supervision. […]

• Immediate jeopardy, isolatedF689Jan 10, 2025

  Based on clinical record review, review of facility's policies and procedures, resident representative and staff interviews the facility failed to recognize risk factors for elopement and adequately supervise 1 (Resident #999) of 3 sampled confused residents when Resident #999 exhibited new symptoms of paranoia and voiced intent to leave the facility. On [DATE] the facility failed to implement adequate supervision when Resident #999's son and law enforcement notified the facility the resident reported he was under attack and requested they come to evacuate him. On [DATE] at approximately 3:30 p.m., Resident #999 who was cognitively impaired was not supervised and exited the facility. Facility staff saw him outside to the right of the building and did not intervene. […]

• Immediate jeopardy, isolatedF867Jan 10, 2025

  Based on record review, review of facility's policies and procedures, the facility failed to thoroughly investigate an elopement incident for 1 (Resident #999) of 3 sampled residents reviewed for elopement, and failed to implement systemic appropriate corrective actions to prevent further incidents of unsafe wandering and elopement of mobile confused residents. On [DATE] the facility failed to ensure Resident #999's safety when the son and law enforcement notified the facility the resident called, said he was under attack, voiced intent to leave the facility and requested they come and get him. On [DATE] at 4:35 p.m., staff became aware Resident #999 was missing and contacted law enforcement to assist with the search. […]

• Actual harm, isolatedF689Oct 28, 2025

  Based on record review, resident and staff interviews, the facility failed to provide restorative nursing services as specified in the care plan resulting in a fracture for 1 (Resident #1) of 3 selected residents who receive restorative nursing services.The findings included:Review of the facility policy and procedure CR14 created 1/2020, revised 11/8/24 revealed, Restorative Nursing Program - General documented Policy: A Restorative Nursing Program enables residents to attain or maintain their highest practicable level of physical, mental, and psychosocial functioning. Restorative goals and objectives are individualized and resident-centered, and are outlined in the resident's plan of care. […]

• Actual harm, isolatedF686Jul 27, 2023

  Based on observation, record review, interview, and review of the facility policies, the facility failed to ensure treatment and services for prevention and management of pressure ulcers were provided in accordance with accepted standards of practice for 3 (Resident #42, #107 and #160) of 8 residents reviewed for pressure ulcers. The findings included: Review of the facility's policy titled, Clean Non-Sterile Dressing Change. Dated 8/2016, showed the facility nurses will use non-sterile but clean aseptic technique for dressing changes. Procedure: Preparation for dressing change item 4. Assemble the equipment and supplies as needed. Steps in the procedure: 2. Place the clean equipment on the clean field. Arrange the supplies so they can be easily reached. […]