Salem West Healthcare Center

In the surveyor’s words

From the most serious findings on record at Salem West Healthcare Center, in the surveyor’s own words.

• Actual harm, isolatedF697Aug 25, 2025

  Based on medical record review, interview and policy review the facility failed to ensure complaints of new onset pain were addressed in a timely manner. This affected one (Resident #34) of three residents reviewed for injuries. The facility census was 81. Actual harm occurred beginning on 06/11/25 when Resident #34, who had a diagnosis of dementia and required assistance with care, complained of pain in the right thigh and lower extremity and demonstrated increased agitation during therapy that was not comprehensively assessed or treated. On 06/12/25, Resident #34 was unable to stand and had ongoing complaints of pain affecting therapy participation and mobility. Facility staff did not notify the resident's medical provider until 06/26/25 at 11:40 P.M. […]

• Actual harm, isolatedF697Sep 3, 2024

  Based on observation, interview, medical record review, and review of facility policy, the facility failed to ensure Resident #13's pain was addressed in a timely and appropriate manner. Actual harm occurred on 08/17/24 when Resident #13, who had an open reduction and internal fixation (ORIF) surgery of a left femur fracture on 08/02/24, was admitted to the facility and the facility failed to develop and implement a comprehensive, individualized and adequate pain management program to provide effective and timely pain relief. Resident #13 displayed signs of pain on admission, during therapy evaluations on 08/19/24 with an increase in severity prior to direct care on 08/20/24 and received no pain interventions. […]

• No harm, potential for more than minimal, widespreadF921Dec 12, 2025

  Based on observation, review of the facility floor plan, and interview, the facility failed to ensure a fire pull station was visible and accessible in the event of an emergency. This had the potential to affect all 70 residents in the facility.Findings Include:Review of the facility floor plan revealed they had 14 fire pull stations in the facility. On 09/28/25 at 4:45 P.M. an interview with Resident #22 revealed he was concerned about the shelving blocking the fire pull station behind the nurse ' s station.An observation 11/03/25 at 10:45 A.M. revealed the wheeled cart of resident charts was stored/parked in front of the fire pull station. […]

• No harm, potential for more than minimal, widespreadF725Apr 29, 2025

  Based on observation, interview, record review, and review of the Payroll Based Journal (PBJ) and facility assessment, the facility failed to provide sufficient nursing staff to meet the total care needs of all residents for their highest practicable physical, mental and psychosocial well -being. This affected four residents (#21, #23, #38 and #42) of five residents reviewed for assistance with activity of daily living (ADL) needs and had the potential to affect all residents in the facility. The facility census was 64. Findings included: 1. […]

• No harm, potential for more than minimal, widespreadF835Apr 29, 2025

  Based on observation, record review, job description review, and interview the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. This had the potential to affect all 64 residents who resided in the facility. Findings include: Review of facility document titled Position Description for position of Executive Director revealed the Administrator had signed the job description on 05/02/23. The description revealed the purpose of this position was to provide leadership to all staff to assure that care standards were met and the highest degree of quality resident care was provided at all times. […]