St. Anthony Healthcare Center

In the surveyor’s words

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

• Immediate jeopardy, isolatedF689Feb 28, 2023

  This Citation pertains to Intake Number M100131450. PNC was accepted for this citation. Based on observation, interview and record review, the facility failed to provide adequate supervision for one resident (R81) of six residents reviewed for elopement by allowing the resident, who was severely cognitively impaired, ambulatory and identified as an elopement risk, to exit the building unbeknownst to facility staff while wearing a Wanderguard bracelet, including use of an alarmed elevator and exiting an alarmed door between approximately 9:15 PM - 9:25 PM on 08/07/2022. This deficient practice resulted in the likelihood of serious injury or death from being unsupervised outside in the dark near a busy four-lane road in the parking lot of a business adjacent to the facility. […]

• Actual harm, isolatedF686Jun 23, 2026

  Based on observation, interview, and record review, the facility failed to prevent the development of pressure ulcers for three residents (R104, R106 and R110) out of three residents with pressure ulcers reviewed, resulting in the development of facility acquired stage 4 (full thickness tissue loss with exposed muscle, tendon and or bone) pressure ulcers. Findings Include: This citation includes intake number 3005546. Resident 104 (R104) Review of the Face Sheet and Minimum Data Set (MDS) with Assessment Reference Date(ARD) of 12/9/25 reflected R104 was a [AGE] year old male admitted to the facility on [DATE] with recent readmission post hospital transfer 3/20/26 related to facility acquired stage 4 (full thickness tissue loss with exposed muscle, tendon and or bone) pressure ulcer, and… […]

• Actual harm, isolatedF686Feb 28, 2023

  This citation pertains to Intake Number MI00132074. Based on observation, interview and record review, the facility failed to complete/document accurate skin/wound assessments, and implement wound care interventions for three sampled residents (R64, R80, and R285) of six residents reviewed for skin care, resulting in unmet care needs and the potential for the worsening of wounds. Findings include: R285 A review of a complaint called into the State Agency revealed the following, My [family member] was not properly cared for in this facility. [R285] was left for several hours in soaked urine and feces, and was not attended by the staff. […]

• No harm, potential for more than minimal, widespreadF812Jun 11, 2025

  Based on observation, interview, and record review, the facility failed to prepare food in accordance with professional standards for food service safety. This deficient practice has the potential to result in food borne illness among all residents that consume food from the kitchen. Findings include: On 6/9/25 between 8:45 AM-9:30 AM, during an initial observation of the kitchen with Dietary Manager F, the following items were observed: The vent hood was observed with a heavy buildup of grease. There was a sticker observed on the vent hood, noting it was last cleaned 3/26/25. Dietary Manager F stated that company comes out every 3 months to clean the vent hood. […]

• No harm, potential for more than minimal, widespreadF925Jun 11, 2025

  Based on observation, interview, and record review, the facility failed to eliminate harborage conditions to maintain an effective pest control program. This deficient practice had the potential to affect all residents in the facility. Findings include: On 6/9/25 at 9:15 AM, there were numerous gnats observed in the dish machine room and near the 3 compartment sink in the kitchen. There was a continuous leak of water onto the floor, from the recessed drain well on the soiled side of the dish machine. In addition, the drain pipe for the sink basin located on the soiled side of the dish machine was leaking water onto the floor. The floor in the dish machine room was very wet, with standing water in the wells between the floor tiles. […]