Pine Point Center

In the surveyor’s words

From the most serious findings on record at Pine Point Center, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF842Jun 2, 2026

  Based on facility policy, record review and interviews, the facility failed to ensure that clinical records were complete and contained accurate information for 1 of 3 residents reviewed for falls (Resident #3) and 3 of 3 residents reviewed for Medication Administration Records (MAR) and Treatment Administration Records (TAR) (Resident #1, #3, and #4). Findings: Facility Policy titled Falls Management states; Any patient who sustains a injury to the head from a fall and/or has a fall unwitnessed by staff will be observed for neurological abnormalities by preforming neurological checks, per facility policy. […]

• No harm, potential for more than minimal, patternF657Apr 9, 2025

  Based on interviews and record review the facility failed to review and revise the care plan by an interdisciplinary team (IDT) meeting, which included the participation of the resident and resident's representative, after each Minimum Data Set (MDS) 3.0 assessment, for 3 of 10 residents whose care plans were reviewed. (Resident #22, #40, #11) Findings: 1. Resident #22's medical record contained a Significant Change MDS, dated [DATE], and Quarterly MDS' dated 8/9/24, 11/7/24, and 1/29/25. The record lacked evidence of IDT meetings being held within 7 days of the above MDS assessments. The medical record stated the last IDT meeting was held on 3/12/24. On 4/8/25 at 11:20 p.m., the above information was discussed with the Market Clinical Advisor. 37015 2. […]

• No harm, potential for more than minimal, patternF684Apr 9, 2025

  Based on record review and interviews, the facility failed to assess and monitor a surgical wound ( Resident#57), failed to follow physician orders for a wound care ( Resident#27) for 2 of 2 resident reviewed for wounds. In additon, the facility failed to obtain physician orders for 1 of 1 resident reviewed for positioning. (Resident #4) Findings: 1. Resident #57 was admitted to the facility in September of 2024, after having a left intertrochanteric femur fracture operation leaving him/her with a surgical wound. Review of the Treatment Administration Record indicated that he/she had Suture/staple removal one time only for Post op left proximal femur on 10/6/24. […]

• No harm, potential for more than minimal, patternF725Apr 9, 2025

  Based on record review, observations and interviews, the facility failed to ensure sufficient direct care staff were scheduled and on duty to meet the needs of residents that reside in the facility for weekends of the first quarter (October 1, 2024 - December 31, 2024). This has the potential to affect all residents needing assistance with Activities of Daily Living (ADLs). Findings: 1. Review of Payroll Based Journal staffing report revealed the facility triggered for low weekend staffing during the first quarter of 2025 (October 1, 2024 - December 31, 2024). On 4/9/25 at 1:56 p.m., both the surveyor and the Director of Nursing reviewed the weekend staffing from October 1, through December 31, 2024. […]

• No harm, potential for more than minimal, patternF761Apr 9, 2025

  Based on observations and interviews, the facility failed to properly secure medications on 1 of 2 (Short Stay Unit) units for 2 of 4 days of survey, failed to ensure expired medications were removed from the supply available for use in 2 of 4 treatment/medication carts reviewed and failed to ensure expired lab supplies were removed from supply available for use on 2 of 2 units (Short Stay and Long Term Units). Findings: 1. On 4/6/25 at 9:02 a.m., observation of the Short Stay unit to have an unlocked and unattended treatment cart containing 4 residents insulin pens, pen needles and lancets, during this time 2 residents were present. At 9:05 a.m., the Certified Nurses Aid #1 confirmed the unlock treatment cart and locked it. 2. […]