Patriot Village

In the surveyor’s words

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

• Immediate jeopardy, patternF600Nov 8, 2023

  Based on review of facility policies, clinical records, and investigation documents, as well as staff interviews, it was determined that the facility failed to ensure that residents were free from abuse for two of four residents reviewed (Residents 1, 2), resulting in Immediate Jeopardy to the resident's physical/mental health and safety. This deficiency was cited as past non-compliance. Findings include: The facility's abuse policy, dated March 22, 2023, revealed that the facility shall provide a safe environment where residents are not subject to mental, physical, sexual, and verbal abuse or neglect by staff, residents, volunteers, consultants, contractors, and other caregivers, visitors or family members. […]

• Immediate jeopardy, patternF607Nov 8, 2023

  Based on review of policies, clinical records, and investigation documents, as well as staff interviews, it was determined that the facility failed to complete a Nurse Aide Registry verification for one of five nurse aides reviewed upon hire (Nurse Aide 2) and staff failed to report physical abuse of one resident (Resident 1) in a timely manner which allowed a second resident to be physically abused (Resident 2) putting all of the residents in danger of being abused, resulting in Immediate Jeopardy to their physical safety. […]

• Immediate jeopardy, patternF689Oct 20, 2023

  Based on a review of facility policies, clinical records, and facility reports, as well as staff interviews, it was determined that the facility failed to ensure that supervision and adequate interventions were in place to prevent a resident from receiving food items from other residents outside of their ordered diet restrictions for one of six residents reviewed (Resident 2), and failed to ensure that supervision and adequate interventions were in place to prevent a resident from giving other residents food items outside of their ordered diet restrictions for one of six residents reviewed (Resident 1). The facility's failure created a situation in which Resident 2 obtained a food item outside of his ordered diet restriction causing him to accidentally choke to death. […]

• No harm, potential for more than minimal, patternF684Jan 8, 2026

  Based on review of clinical records, as well as staff interviews, it was determined that the facility failed to ensure that residents received care and treatment in accordance with professional standards of practice, by failing to ensure that physician's orders were followed for one of 36 residents reviewed (Resident 23). Findings include: A comprehensive significant change in status Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 23, dated December 13, 2025, revealed that the resident was cognitively impaired, required assistance with daily care needs, received hypoglycemic medications including insulin and had a diagnosis of diabetes. […]

• No harm, potential for more than minimal, patternF694Jan 8, 2026

  Based on review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that a long-term intravenous catheter and a midline catheter (a type of peripheral catheter inserted into a large vein in the upper arm used to deliver fluids and/or medications) were flushed prior to and/or after medication administration for two of 36 residents reviewed (Residents 4, 10).Findings include: The facility's policy regarding peripheral and midline IV catheter flushing dated December 31, 2025, included flushing before and after medication or fluid administration by attaching a prefilled saline syringe to the needleless access device to ensure the entire dose of the medication is administered.A significant change Minimum Data Set (MDS)… […]