The Living Centre

In the surveyor’s words

From the most serious findings on record at The Living Centre, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Dec 7, 2023

  Based on interview and record review, the facility licensed nursing staff failed to thoroughly assess one resident to ensure appropriate transfer services and necessary medical assessments were completed and thoroughly documented after a resident's fall, and the resident sustained fractures, a broken tooth, and a head injury during the fall for 1 (#9). Nursing staff then directed CNA staff to transfer the resident from the floor using a mechanical lift, to her bed. This increased the risk for injury. Upon transfer to the ER, it was found the resident had significant injuries, to include fractures of her C-1 and C-2, a broken tooth, and a head laceration and was admitted to the Intensive Care Unit. […]

• Actual harm, isolatedF600Jun 3, 2024

  Based on interview and record review, the facility failed to protect one (#1) of 1 sampled resident from verbal and physical abuse by a caregiver. This deficiency caused the resident to cry out in pain and had the potential to affect the resident's mental health. Findings include: During an interview on 6/3/24 at 11:38 a.m., NF1 said she and her partner arrived at the facility, to take a resident to the Emergency Department, after the resident fell and was complaining of leg pain. NF1 said the resident was well known to the ambulance service. NF1 said when she and her partner arrived at the resident's room, staff member C met them at the door. Staff member D handed them the transfer paperwork and told them to wait outside the room. […]

• No harm, potential for more than minimal, patternF636Dec 7, 2023

  Based on interview and record review, it was identified the facility failed to ensure individualized fall care plans were updated, to reflect the identification and implementation of beneficial fall interventions, for residents with falls, for 2 (#s 4 and 9) of 5 sampled residents, and #4 had recurrent falls so the opportunity was missed several times for the care plan modifications, and #9 returned to the facility on comfort care with fractures, and with the various medical changes, the care plan was not modified to address them adequately. Findings include: 1. Record review of resident #9's Fall Risk Evaluation form, showed the resident was assessed and determined to be considered a high fall risk, effective 1/30/23. […]

• No harm, potential for more than minimal, isolatedF657Feb 26, 2026

  Based on observation, interview, and record review, the facility failed to update a comprehensive care plan with a resident's preferences for tobacco use for 1 (#35) of 21 sampled residents. Findings include:During an observation and interview on 2/23/26 at 12:51 p.m., resident #35 was in his bed and stated he was waiting for lunch. An over-the-bed table was in front of him, and it had a can of [NAME] (Tobacco) pouches sitting on it. During an interview on 2/24/26 at 1:18 p.m., staff member G stated he did not know of any resident in the facility who used tobacco products. […]

• No harm, potential for more than minimal, isolatedF695Feb 26, 2026

  Based on observation, interviews, and record review, the facility failed to obtain a physician's order for oxygen for 1 (#15); and failed to ensure the residents' oxygen tubing was clean and changed regularly for 2 (#s 14 and 15) of 21 sampled residents. Findings include:1. During an observation on 2/23/26 at 12:48 p.m., an oxygen concentrator was observed in resident #14's room with a tag on the tubing that had written initials and a date of 1/21/26. The oxygen tube had water built up inside it.During an interview on 2/23/26 at 1:13 p.m., resident #14 stated she did not know when the oxygen tubing was last changed on her oxygen concentrator.Review of resident #14's medication administration record for February 2026 showed: Physician order: Change oxygen tubing every 15 days, every night… […]