Sunrise Skilled Nur & Rehab

In the surveyor’s words

From the most serious findings on record at Sunrise Skilled Nur & Rehab, in the surveyor’s own words.

• Immediate jeopardy, isolatedF757May 22, 2025

  Based on interview and record review, the facility failed to obtain physician ordered laboratory testing in 1 of 3 residents (R2), reviewed for medication monitoring in the sample of 9. This failure resulted in R2 being admitted to the hospital on 5/8/25, where he remains. R2 was diagnosed in the hospital with Supratherapeutic INR (Initial Normalized Ratio) with a level greater than 10 (target range is between 2-3) and had to receive medication to reverse the effects from the anticoagulant, Warfarin, that R2 was receiving in the facility for a diagnosis of Pulmonary Embolism. This failure resulted in an immediate jeopardy when the facility failed to obtain laboratory testing to monitor R2's anticoagulant levels to ensure a therapeutic level was obtained. […]

• Actual harm, isolatedF689Oct 14, 2025

  Based on Interview, and Record Review, the facility failed to properly transfer 1 of 4 residents (R2), reviewed for appropriate safe transfers in the sample of 4. This failure resulted in R2 having a fall, sustaining a right hip fracture and ultimately passing away. The Findings Include: R2's admission Record, dated [DATE], documents R2 was originally admitted to the facility on [DATE] and was discharged on [DATE] with diagnosis of Cerebral Atherosclerosis, Dementia, Anemia, Hypertension, Atherosclerosis of Aorta, Generalized Anxiety Disorder, Major Depressive Disorder, Abdominal Aortic Aneurysm, Osteoporosis, Disorders of bone density and structure, Personal history of (healed) traumatic fracture left humerus.R2's Care Plan, dated as complete on [DATE], documents R2 has a Self-Care… […]

• Actual harm, isolatedF689Aug 1, 2025

  Based on observation, interview and record review the Facility failed to ensure residents were supervised to prevent accidents for 1 of 3 residents (R2) reviewed for falls in the sample of 5. This failure resulted in R2 being left unsupervised in bed in the high position on a low airloss mattress causing R2 to fall from the bed sustaining multiple fractures to both legs.Findings include: R2's July 2025 Physician Order Sheet (POS) document a displaced comminuted fracture of shaft of left fibula subsequent encounter for closed fracture with routine healing (dated 7/28/2025); osteomyelitis of vertebra, sacral and sacrococcygeal region, type 2 diabetes mellitus without complications, unspecified fracture of lower end of left tibia, subsequent encounter for closed fracture with routine healing… […]

• Actual harm, isolatedF580Mar 15, 2023

  Based on interviews and record review, the facility failed to notify resident representative of a worsening condition to a coccyx wound for 1 (R2) out of sample of 3 and failed to consult with Physician and/or Physician's Assistant. This failure resulted in R2 being sent to the emergency room for treatment per family request. Findings include: 1.) R2's diagnosis include essential tremors, hypothyroidism, peptic ulcer, anxiety, and osteoporosis. R2's Minimum Data Set, (MDS), dated [DATE] documents, a mental status of 14 which indicates R2 is cognitively intact. MDS documents, that R2 requires supervision with eating, dressing, toileting, transfers, and personal hygiene. On 03/08/23 at 10:25am, V12, (R2's POA), states she nor her husband received notification about the burn on 02/28/2023. […]

• Actual harm, isolatedF684Mar 15, 2023

  Based on observations, interviews and record review the facility failed to provide treatment for for 1 of 3 (R2, R5, R6) residents reviewed for wounds. This failure resulted in R2 being sent to the emergency room for treatment per family request on 3/6/2023 and wound specialist consultation on 3/8/2023 with diagnosis of deep tissue injury measuring 11.5 x 15.5 with 60% necrotic tissue, 30% devitalized necrotic tissue. Findings include: R2's diagnosis include essential tremors, hypothyroidism, peptic ulcer, anxiety and osteoporosis. R2's Minimum Data Set, (MDS), dated [DATE] documents a brief interview of mental status of 14 which indicates R2 is cognitively intact. […]