Shippenville Nursing and Rehab

In the surveyor’s words

From the most serious findings on record at Shippenville Nursing and Rehab, in the surveyor’s own words.

• Actual harm, isolatedF684Sep 23, 2022

  Based on a review of clinical records, facility documentation, and facility policies, and staff and resident interviews, it was determined that the facility failed to provide immediate care and services to include emergency services regarding a fall impacting both knees that was later identified as bilateral patella (kneecaps) fractures with actual harm of continued pain for over 24-hours for one of 23 residents reviewed (Resident R51). Findings include: Review of the facility policy entitled, Assessing Falls and Their Causes dated 7/13/22, revealed that if evidence of an injury is found, apply first aid and/or obtain medical treatment immediately. The policy also revealed that assessments of delayed complications from a fall should occur for 48 hours after the fall. […]

• No harm, potential for more than minimal, patternF565Jun 13, 2025

  Based on review of facility policy, facility documents, and resident and staff interviews, it was determined that the facility failed to correct Resident Council concerns for a period of six months (January 2025 through June 2025). Findings: Review of facility policy, Resident Council, dated 2/18/25, indicated A Resident Council Response Form will be utilized to track issues and their resolution. The facility department related to any issues will be responsible for addressing the item(s) of concern. The Quality Assurance and Performance Improvement (QAPI) Committee will review information and feedback from Resident Council as part of their quality review. […]

• No harm, potential for more than minimal, patternF725Jun 13, 2025

  Based on review of clinical records, facility policies and facility documents, observations, resident and staff interviews, it was determined that the facility failed to provide sufficient nursing staff and services to promote the physical and mental well-being and meet the needs for 10 of 26 residents interviewed (Residents R3, R7, R21, R27, R42, R60, R76, R77, R93, and R199). Findings include: Review of facility policy entitled, Answering the Call Light dated 2/18/25, revealed If the resident's request is something you can fulfill, complete the task within five minutes if possible. Review of facility policy entitled Resident Showers dated 2/18/25, revealed Residents will be provided showers as per request or as facility schedule protocols . […]

• No harm, potential for more than minimal, patternF812Jun 13, 2025

  Based on review of facility policies, observations, and staff interview, it was determined that the facility failed to serve food in a safe and sanitary manner during tray line and ensure that food was stored in accordance with standards for food safety in the main kitchen, and resident pantries (D Wing, A Wing, Skilled Wing pantries and Kitchen). Findings include: Review of a facility policy entitled Floor stock and Supplement Distribution dated 2/18/25, revealed discarding expired and unlabeled products ., Supplements such as . Med Pass . […]

• No harm, potential for more than minimal, patternF812Aug 31, 2023

  Based on review of a facility policy, observations, and staff interviews, it was determined that the facility failed to ensure that food was stored in accordance with standards for food safety in three of three unit refrigerators reviewed (Unit A, Unit B, Dementia Unit). Findings include: Review of facility policy entitled Food Receiving and Storage dated 4/28/23, indicated that open containers are labeled, dated and toxic substances will be stored in separate storage areas from food. Review of facility policy entitled Refrigerators and Freezers dated 4/28/23, indicated that refrigerators and freezers are kept clean and free of debris. Observation on 8/30/23, at 10:45 a.m. […]