The Laurels of Sandy Creek

In the surveyor’s words

From the most serious findings on record at The Laurels of Sandy Creek, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880Jan 22, 2021

  This citation has two (2) Deficiency Practice Statements (DPS) Deficient Practice Statement #1 Based on observation, interview, and record review, the facility failed to follow standard infection control practice per CDC (Centers for Disease Control) guidance for cohorting allowing for the spread of COVID-19 in 11 of 30 residents reviewed for infection control, resulting in an IJ (Immediate Jeopardy) when beginning on 5/15/2020 residents were improperly cohorted per CDC. In total, 25 residents tested positive for COVID-19 with three resident (3) deaths. This deficient practice placed all 69 residents residing in the facility at risk for serious harm and/or death. […]

• Immediate jeopardy, isolatedF689Oct 22, 2025

  This citation pertains to intake # 2642001Based on interview, and record review, the facility failed to provide adequate supervision to prevent elopement and respond appropriately to an alarming exit door to ensure resident safety in 1 of 3 residents (Resident #101) reviewed for elopement/supervision, resulting in an Immediate Jeopardy when on 10/2/25 between 6:15 AM and 6:30 AM, Resident #101, who was an elopement risk, exited the facility, unbeknownst to facility staff, and was found by a Activities Director (AD) E approximately 50 yards away from the facility, in his wheelchair on the sidewalk of the road. […]

• Immediate jeopardy, isolatedF604Jul 13, 2022

  This citation pertains to intake: MI 333. Based on interview and record review, the facility failed to prevent the use of a physical restraint, utilized for the sole purpose of staff convenience, on 1 of 5 sampled residents (Resident #201) reviewed for physical restraints, resulting in an Immediate Jeopardy (IJ) when on 6/16/22 at approximately 8:15 PM, Resident #201, a cognitively impaired resident with known behaviors and a documented history of falls, was found sitting in their wheelchair with a gait belt applied around her waist and the back of the wheelchair such that Resident #201 could not get up. […]

• Immediate jeopardy, isolatedF610Jul 13, 2022

  This citation pertains to intake: MI 333. Based on interview and record review, the facility failed to prevent the likelihood for ongoing abuse for 1 resident (Resident #201) of 5 residents reviewed for abuse, resulting in an Immediate Jeopardy (IJ) that began on 6/16/22 at 8:15 PM when CNA C, after confirmation that CNA C had applied a physical restraint to Resident #201 for staff convenience, was permitted to remain at the facility, providing direct care to their assigned residents, including Resident #201, for the remainder of their shift (which ended at 6:00 AM the next morning). This deficient practice had the high likelihood to affect all vulnerable residents assigned to CNA C during that time. Findings include: Review of a Face Sheet revealed Resident #201 was a female. […]

• Actual harm, isolatedF741Feb 5, 2025

  This citation pertains to intake number MI00148293. Based on interview and record review, the facility failed to ensure staff had appropriate competencies and skills needed to provide care in a manner that supported their psychosocial wellness in 1 (Resident #102) of 6 residents reviewed for behavioral competency, resulting in inappropriate staff to resident interactions, inability of staff to appropriately address the psychological distress, unmet care needs, and resident not maintaining or achieving highest practical psycho-social well being. […]