Plainfield Health Care Center

In the surveyor’s words

From the most serious findings on record at Plainfield Health Care Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF744Jan 21, 2026

  Based on observation, interview, and record review, the facility failed to provide supervision and interventions for an aggressive dementia resident (Resident L) on the locked dementia unit resulting in the resident forcibly removing another resident (Resident N) out of her wheelchair causing bruising to her eye and nose. This deficiency had the ability to affect 21 of the 21 residents residing on the locked dementia unit. The immediate jeopardy began on 12/30/25 when Resident L wanted Resident N's wheelchair and forcibly removed her from the wheelchair resulting in bruising and swelling to Resident N's right eye and nose. Resident L had previously wandered into another resident's room and punched a staff member when they attempted to re-direct him on 12/12/25. […]

• Immediate jeopardy, isolatedF689Mar 22, 2024

  Based on observation, interview, and record review, the facility failed to provide effective supervision to prevent a cognitively impaired resident from exiting the second story locked memory care unit through an open window located approximately 13 feet above the ground by using a gait belt and failed to conduct an elopement assessment when the cognitively impaired resident verbalized the intention to elope from the facility for 1 of 3 residents reviewed for accidents. Resident B sustained a fractured left heel, a fractured left ankle, two fractures of the sacral vertebras, and a thoracic vertebra fracture (Resident B). […]

• Immediate jeopardy, isolatedF744Mar 22, 2024

  Based on observation, interview, and record review, the facility failed to provide individualized dementia care and supervision of a newly admitted resident with Alzheimer's dementia for 1 of 3 residents reviewed for dementia care (Resident B) which resulted in the resident exiting the locked memory care unit through a second story window approximately 13 feet above the ground and fracturing her left heel, left ankle, two sacral vertebrae, and a thoracic vertebra. The immediate jeopardy began on 3/15/24 when a cognitively impaired resident with a diagnosis of Alzheimer's dementia was admitted to the nonsmoking locked memory care unit. […]

• Actual harm, isolatedF684Mar 11, 2026

  Based on record review and interview, the facility failed to identify and provide wound care services by ensuring wound assessments and treatments were provided to prevent worsening wounds for 1 of 3 residents reviewed for wound care (Resident B).Findings include:On 3/11/26 at 3:00 p.m., during a phone interview, Resident B indicated she received good care, but the facility did not change her wound dressings for 10 days after admission. She indicated the staff looked at her leg wounds but did not change the dressings. On 3/10/26 at 10:30 a.m., the medical record of Resident B was reviewed. The resident was admitted to the facility from a local hospital on 1/8/26. […]

• Actual harm, isolatedF692Dec 6, 2022

  Based on observation, interview, and record review, the facility failed to ensure residents received assistance, supplements, and appetite stimulants to maintain for weight for 2 of 4 residents reviewed for nutritional status (Residents 70 and 58) resulting in harm due to significant weight loss for both residents; and the facility failed to maintain hydration resulting in abnormal lab values for 1 of 4 residents reviewed for assessments (Resident 58). Findings include: 1. On 12/2/22 at 11:46 a.m., Resident 70's medical record was reviewed. The medical record indicated on 8/9/22 she weighed 107.2 pounds and on 8/15/22 she weighed 106.8 pounds. A physician's progress note, on 8/11/22 at 3:03 p.m., indicated Resident 70's weight and blood pressure remain stable at 107 pounds. […]