Pine Grove Healthcare & Wellness Centre, LP

In the surveyor’s words

From the most serious findings on record at Pine Grove Healthcare & Wellness Centre, LP, in the surveyor’s own words.

• Actual harm, isolatedF689Feb 8, 2023

  Based on observation, interview, and record review, the facility failed to supervise one of three sampled residents (Resident 1) to prevent resident while in his wheelchair, from rolling out from the transportation van onto the pavement causing the wheelchair ' s footrest to retract and pushing against resident ' s legs while the resident was being transported from the facility to the doctor ' s office. This deficient practice resulted to Resident 1 ' s accident on 12/8/2022, sustaining a right tibial (along the length of the bone, below the knee and above the ankle) fracture (a complete or partial bone break). […]

• No harm, potential for more than minimal, patternF726Mar 19, 2026

  Based on interview and record review, the facility failed to ensure competencies and skills sets to provide nursing and related services were completed for five (5) of 5 sampled nursing staff in accordance with the facility assessment and policy and procedures (P&P). This deficient practice has the potential to result in an increased risk for improper care provided to the residents which could negatively affect the residents' overall wellbeing.Findings:During a concurrent review and interview on 3/18/2026 at 2PM with the Director of Staff Development (DSD), Certified Nurse Assistant 1's (CNA 1) employee records were reviewed. The DSD stated CNA 1 was hired on 2/13/2025. […]

• No harm, potential for more than minimal, patternF814Mar 19, 2026

  Based on observation, interview and record review, the facility failed to ensure garbage was properly disposed of in accordance with the facility's policy and procedure titled, Waste Management. This deficient practice had the potential to attract pests and rodents and may cause disease and other health issues to residents, staff, and the community.Findings: During a concurrent observation and interview on 3/16/2026 at 8:01 AM with the Dietary Supervisor (DS), in the facility's parking lot, two lidless/uncovered trash bins with wheels were filled with bags of trash placed next to three dumpsters. DS stated the two trash bins were filled with nursing trash and were not covered and the two trash bins should be covered. […]

• No harm, potential for more than minimal, patternF842Mar 19, 2026

  Based on interview and record review, the facility failed to ensure vital (objective, measurable indicators of the body's most essential physiological functions, used to evaluate physical health, monitor illness, which includes blood pressure) were documented accurately for two (2) of three (3) sampled residents (Residents 5 and 82) reviewed for dialysis. This failure resulted in the facility not documenting blood pressure readings were taken in the correct arm for Residents 5 and 82 which can lead to potential harm and/ or injury to the residents. Findings: 1. […]

• No harm, potential for more than minimal, patternF880Mar 19, 2026

  Based on interview and record review, the facility did not implement water testing samples (to collect and deliver for analysis a sample of water representative of the bulk of water being examined) to initially validate the facility's water management program control measures (actions that can be taken to reduce the potential of exposure to a hazard) to ensure the facility's water was free of waterborne (carried or transmitted by water and especially by drinking water) pathogens (any organism that can cause disease) such as legionella (a bacterium which cases legionnaires' disease [a severe form of pneumonia - lung inflammation usually caused by infection]). […]