Park Place

In the surveyor’s words

From the most serious findings on record at Park Place, in the surveyor’s own words.

• Actual harm, isolatedF689Jun 10, 2026

  Based on clinical record review, policy review, and staff interview, the facility failed to implement care plan interventions to prevent a fall with a major injury for 1 of 3 residents (Resident #2) reviewed with a high fall risk. The facility reported a census of 34 residents.Findings include:The Minimum Data Set (MDS) assessment tool dated 4/8/26, listed Resident #2 diagnoses, which included the presence of a left artificial knee joint, osteoarthritis (inflammation of the bones and joints), and heart failure. The MDS identified that the resident depended on staff for toileting hygiene, toilet transfers, and chair transfers. The Brief Interview for Mental Status (BIMS) score of 15 out of 15, indicated intact cognition. The MDS listed an admission date of 12/29/23. […]

• No harm, potential for more than minimal, widespreadF837Jul 31, 2023

  Based on interview, record review, facility job description review, the facility failed to ensure the Administrator was appropriately licensed to act as the Administrator for the facility. The facility reported a census of 31. During the entrance conference on 7/24/23 at 11:12 AM, the DON (Director of Nursing) stated the Administrator was currently at the other facility she managed and wouldn't make it to this facility today. During an interview on 7/26/23 at 9:25 AM, the Administrator queried to supply a copy of her license and she stated she didn't have a license, she had a provisional license for the other facility (not facility surveyed at present time). She stated she was in the process of getting a waiver. […]

• No harm, potential for more than minimal, patternF803Aug 13, 2026

  Based on observation, policy review and staff interview, the facility failed to ensure 3 of 3 residents on a pureed diet received margarine and the correct portion of bread and vegetables and failed to ensure multiple residents on a regular diet received the correct portion of meatloaf. The facility reported a census of 29 residents.Findings included:a. The Week 1 Tuesday menu for the noon meal directed staff to serve those on a pureed diet a #10 scoop( to a half cup) of italian blend vegetables and 1 piece of bread with margarine.On 8/11/26 at 10:51 a.m., Staff M [NAME] added 2 4 ounce scoops of vegetables to the food processor and blended to a pureed consistency. Staff M then added 2 pieces of bread without margarine. Staff M stated she was making 2 servings of vegetables. […]

• No harm, potential for more than minimal, patternF812Aug 13, 2026

  Based on observation, policy review, and staff interview, the facility failed to maintain adequate kitchen sanitation for 2 of 2 kitchen observations. The facility reported a census of 29 residents.Findings included:During the initial kitchen tour on 8/10/26 at 9:15 a.m., thick dust particles hung down from the spigots of the fire suppression system located above the stove burners. A pot simmered on a stove burner under the dusty spigots.During a follow-up tour of the kitchen on 8/11/26 at 10:28 a.m., dust remained on 3 spigots of the fire suppression system located above the stove burners. The dust particles appeared loose as if they could easily fall off. The undated facility policy Nutrition Services stated the facility would implement cleaning schedules and monitor for cleanliness. […]

• No harm, potential for more than minimal, patternF880Aug 13, 2026

  Based on observations, clinical record review, policy review, and staff interview, the facility failed to carry out adequate infection control practices for 1 of 2 residents observed during a dressing change(Resident #8), 1 of 1 resident observed during catheter cares(Resident #2), 1 of 1 resident observed during a blood sugar check(Resident #24), and for 1 of 1 resident observed during perineal cares(Resident #7). The facility reported a policy of 29 residents. Findings included: 1. The Minimum Data Set(MDS) assessment, dated 6/10/26, listed diagnoses for Resident #8 which included high blood pressure, hip fracture, and osteoporosis(brittle bones). […]