Senior Village Healthcare

In the surveyor’s words

From the most serious findings on record at Senior Village Healthcare, in the surveyor’s own words.

• Actual harm, isolatedF689May 13, 2021

  Based on observation, interview, and record review, it was determined the facility failed to provide adequate assistance to prevent an accident for one (#10) of three residents reviewed for accidents and/or falls. The facility failed to provide two-person assistance when transferring the resident, which resulted in a fall with fracture. The Administrator reported 34 residents resided in the facility. Findings: Resident #10 was admitted to the facility on [DATE] with diagnoses which included dementia, benign neoplasm of cerebral meninges, history of falls, right artificial knee joint, and hypertension. A progress note, dated 04/25/20, documented the resident became weak and stepped sideways on her right ankle. […]

• No harm, potential for more than minimal, widespreadF812Jul 2, 2026

  Based on interview, observation, facility document and policy review, and the United States Food and Drug Administration 2022 Food Code, the facility failed to ensure food items were stored in a sanitary manner. Specifically, the facility failed to ensure opened items were properly labeled and dated in a facility freezer, failed to ensure items were labeled with a date and name prior to storage in the resident nourishment refrigerator, and failed to maintain temperature logs in the resident nourishment refrigerator.Findings included: The U.S. […]

• No harm, potential for more than minimal, widespreadF812May 13, 2021

  Based on observation and interview, it was determined the facility failed to maintain a clean and sanitary kitchen that was kept in good repair. The facility identified 34 residents received meals from the kitchen. Findings: On 05/10/21 at 9:45 a.m. and again on 05/11/21 at 2:55 p.m., a tour of the kitchen was conducted. The following was observed: ~ the flooring was observed to be torn and pavement exposed throughout the kitchen, ~ debris, which included material that appeared to be white broken pieces, a butter knife, blue plastic, a smashed butter packet, a smashed cup of cream, and white and brown pieces of paper were observed on the floor, under the counters, and along the wall in the dishwasher area, ~ missing pieces of the wall with pipes exposed, brown residue splattered on the… […]

• No harm, potential for more than minimal, patternF584Jul 2, 2026

  Based on observation, interview, and facility policy review, the facility failed to provide a homelike environment for 8 (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], and room [ROOM NUMBER]) of 28 rooms. Specifically, the privacy curtains in eight resident rooms had visible stains of varying sizes.Findings included: A facility policy titled, Resident's Rights and Confidentiality, revised 08/01/2017, revealed, At the facility it is your responsibility to protect and promote the rights of each resident, including the following: and included, 29. The right to a safe, clean, comfortable homelike environment. […]

• No harm, potential for more than minimal, patternF684Aug 1, 2024

  Based on observation, record review, and interview, the facility failed to ensure physicain's orders were followed as ordered for one (#32) of one resident reviewed for respiratory care. The Administrator reported 44 residents resided in the facility. Findings: Res #32 admitted to the facility with diagnoses of COPD, depression, and diabetes. A physician's order, dated 06/28/24, documented Oxygen 5 liters via NC if O2 sats are less than 90%. On 07/29/24 at 9:27 a.m., the resident was observed resting in bed with eyes closed. Oxygen settings were observd at 7 L/M with a nasal canula. On 07/30/24 at 12:25 p.m., the resident was observed wearing their oxygen. Oxygen settings were at 7 L/M via NC. On 07/31/24 at 9:32 a.m., the resident was observed sitting in their room watching tv. […]