Ridgeview Health Services, Inc

In the surveyor’s words

From the most serious findings on record at Ridgeview Health Services, Inc, in the surveyor’s own words.

• Actual harm, isolatedF684Aug 8, 2025

  Based on interviews, record review, review of a facility policy titled, Negative Pressure Wound Therapy, review of Resident Identifier (RI) #150's hospital records and review of a complaint received by the State Agency, the facility failed to provide, in a timely manner, a wound vacuum (vac) as prescribed by RI #150's hospital physician. On 11/10/2022 RI #150 was admitted to the facility with hospital physician orders for a wet-to-dry packing and a wound vac was to be placed to RI #150's right abdominal surgical wound once RI #150 was admitted to the facility. According to facility staff the wound vac was not placed until 11/14/2022, four days after RI #150 was admitted to the facility. […]

• No harm, potential for more than minimal, isolatedF600Aug 8, 2025

  Based on interviews, record review, review of a Facility Reported Incident (FRI), review of the facility investigative file and a facility policy titled Abuse, Neglect and Exploitation the facility failed to protect Resident Identifier (RI) #152's right to be free from physical abuse perpetrated by another resident, RI #151. On 03/31/2023, Certified Nursing Assistant (CNA) #12 witnessed RI #151 physically abuse RI #152, a cognitively impaired resident, when RI #151 was found in RI #152's room placing a pillow over RI #152's head while RI #152 was in bed. The facility failed to provide adequate supervision and interventions for RI #151, a resident with a history of wandering and aggressive behaviors, to prevent other residents from being abused by RI #151. […]

• No harm, potential for more than minimal, isolatedF689Aug 8, 2025

  Based on observations, record review, interviews and review of a facility policy titled, ACCIDENT/INCIDENT STAFF RESPONSIBILITY, the facility failed to ensure Resident Identifier (RI) #16's fall interventions to have mats on the floor on both sides of the bed; and for the bed to be lowered for safety was being implemented on three of four days of the survey. This affected RI #16, one of four residents sampled for accidents. Findings Include: Review of a facility policy titled, ACCIDENT/INCIDENT STAFF RESPONSIBILITY, with a revision date of 08/08/2022 revealed the following: . Accident refers to an unexpected or unintentional incident, which may result in injury or illness to a resident . […]

• No harm, potential for more than minimal, isolatedF740Aug 8, 2025

  Based on observations, interviews, resident record review, and review of a facility's policy titled Behavioral Health Services, the facility failed to ensure Resident Identifier (RI) #151, a resident with behaviors that were difficult to manage, had interventions and supervision to prevent abuse of other residents and to protect other residents and ensure safety and privacy from RI #151's aggressive wandering behaviors. This deficient practice affected RI #151 and RI #152 two of four residents sampled for behaviors. […]

• No harm, potential for more than minimal, isolatedF803Aug 8, 2025

  Based on observation, interview, the facility's 2025 Spring/Summer Menu for Wednesday - Day 11, the facility's Portioning Utensils document, and the facility's policies for Menu Planning and Menu Substitution Lists, the facility failed to ensure the correct portions of pureed food were served at Dinner/Supper on 08/06/2025.This had the potential to affect three of eleven residents receiving a Pureed Diet. Findings Include: The facility's policy for Menu Planning, dated 2023, included the following: . Policy:Nutritional needs of individuals will be provided in accordance with the established national standards .Procedure:1. a. […]