Trinidad Rehabilitation and Healthcare Center

In the surveyor’s words

From the most serious findings on record at Trinidad Rehabilitation and Healthcare Center, in the surveyor’s own words.

• Actual harm, isolatedF686Jan 20, 2022

  Based on resident record review, and interviews, the facility failed to ensure residents received care consistent with professional standards of practice to prevent pressure injuries for one (#1) of three residents out of eight sample residents. On 11/18/21 a pressure injury was found on Resident #1 sacrum which measured 2.5 cm (centimeters) long by 1 cm wide. At that time, the facility only implemented repositioning for the resident every two hours; no additional interventions or treatments were ordered for the resident. According to the documentation in Resident #1's medical record, the pressure injury was not assessed until 11/23/21, which was five days later. […]

• No harm, potential for more than minimal, widespreadF812Jun 5, 2024

  Based on observations and interviews, the facility failed to store, prepare, distribute, and serve food in a sanitary manner in the facility's kitchen and dining room. Specifically, the facility failed to: -Ensure nourishment beverages in the main dining room and unit refrigerators were dated and labeled; -Ensure cooking utensils were dried appropriately; -Ensure food preparation area vents were free from hanging dust and lint; -Ensure the main dining room refrigerator maintained a safe operating temperature; and, -Ensure dented food cans were not used. Findings include: I. Ensure nourishment beverages in the main dining room and unit refrigerators were dated and labeled. A. […]

• No harm, potential for more than minimal, patternF600Feb 18, 2026

  Based on record review and interviews, the facility failed to ensure residents were kept free from physical abuse for six (#3, #1, #7, #2, #5 and #6 ) of 9 residents reviewed for abuse out of nine sample residents.Specifically, the facility failed to: -Protect Resident #3 from physical abuse by Resident #4;-Protect Resident #1 from physical abuse by Resident #2;-Protect Resident #7 and Resident #2 from physical abuse by each other; and,-Protect Resident #5 and Resident #6 from physical abuse by each other.Findings include:I. Facility policy and procedureThe Abuse Investigating and Reporting policy, revised July 2017, was provided by the nursing home administrator (NHA) on 2/18/26 at 2:04 p.m. […]

• No harm, potential for more than minimal, patternF730Jun 5, 2024

  Based on record review and interviews, the facility failed to complete a performance review of every nurse aide at least once every 12 months and provide regular in-service education based on the outcome of these reviews for four of four staff reviewed. Specifically, the facility had not completed annual performance reviews and/or provided regular in-service education based on the outcome of the reviews for certified nurse aide (CNA) #2, CNA #3, CNA #5 and CNA #6. Findings include: I. Record review CNA #2 (hired on 2/1/11), CNA #3 (hired on 7/26/11), CNA #5 (hired on 4/5/23) and CNA #6 (hired on 1/26/21) did not have an annual performance review completed. The CNAs did not have an in-service education plan based on the outcome of the review. II. […]

• No harm, potential for more than minimal, isolatedF684Dec 5, 2025

  Based on observations, record review and interviews, the facility failed to ensure residents received treatment and care in accordance with professional standards for one (#1) of five residents reviewed for failure to transcribe and initiate the physician's orders out of nine sample residents.Specifically, the facility failed to ensure Resident #'1 post hospitalization orders for hematoma care were entered into the electronic medical record (EMR) and followed. Findings include:I. Facility policy and procedureThe Hematoma Aftercare procedure, undated, was received from the nursing home administrator (NHA) on [DATE] at 2:36 p.m. […]