Vernon Healthcare Center

In the surveyor’s words

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

• Immediate jeopardy, widespreadF725Jun 28, 2022

  Based on observation, interview and record review, the facility failed to ensure there were Licensed Vocational Nurses (LVNs) and Registered Nurses (RNs) to provide nursing services to 57 of 84 residents (Residents 1-57) and failed to provide LVNs and RNs to care for 3 of 3 residents (Residents 2, 4, and 5) in need of nursing care: 1. No LVNs or RNs were assigned to medication cart 1 for 29 residents and medication cart 3 for 28 residents to administer scheduled medications on June 16, 2022, on the 7 am. to 3 pm shift and the 3-11 pm shift. The residents did not receive scheduled medications. 2. No nurse was available to medicate Resident 2, who was in pain and required pain medication. 3. […]

• Immediate jeopardy, widespreadF760Jun 28, 2022

  Based on interview, and record review, the facility failed to: 1. Administer 170 doses of insulin (medications used to treat high blood sugar) to 12 out of 32 sampled residents (Residents 6, 7, 8, 15, 19, 26, 27, 28, 31, 32, 34, and 37) between 6/1/22 and 6/15/22. 2. Administer 102 doses of anticonvulsants (medications used to prevent seizures [uncontrolled electrical activity in the brain]) for 18 out of 32 sampled residents (Residents 7, 10, 11, 12, 14, 16, 17, 18, 19, 21, 23, 24, 25, 29, 30, 33, 35, and 36) between 6/1/22 and 6/15/22. 3. Administer 29 doses of anticoagulants (medications used to prevent blood clots) for 7 out of 32 sampled residents (Residents 6, 9, 13, 14, 20, 22, and 37) between 6/1/22 and 6/15/22. […]

• Immediate jeopardy, patternF697Jun 28, 2022

  Based on observation, interview and record review, the facility failed to provide pain management to four of four sampled residents (Residents, 2, 3, 4, and 5) as indicated in the residents' plan of care. All four residents requested pain medication, and no one was available to assess and administer medication to the residents. This deficient practice caused Residents 2, 3, 4 and 5 to be in severe pain for extended (10- 12) hours. On 6/16/2022 at 6:22 p.m., an Immediate Jeopardy (IJ), a situation in which the facility's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident was declared and the facility's assistant administrator was notified of the serious findings regarding failure to… […]

• Immediate jeopardy, isolatedF627May 5, 2025

  Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1), was safely discharged to a lower level of care by failing to: 1. Follow its policy and procedure (P&P) titled, Discharge and Transfer of Residents, which indicated the facility may discharge a resident if the services provided by the facility were no longer required, when Resident 1, who required the services provided by the facility was discharged to a Board and Care facility ([B&C] a small residential home that provides lower-level of care and supervision to seniors who need assistance with daily living tasks but do not require 24-hour nursing care). 2. Ensure Resident 1 was safely discharged to B&C 1. […]

• Actual harm, isolatedF600Jul 8, 2026

  Based on observation, interview, and record review, the facility failed to ensure one of four sampled residents (Resident 1) was free from physical abuse by failing to protect Resident 1 from a physically aggressive resident (Resident 2), when Resident 2 physically abused Resident 1. This deficient practice resulted in Resident 1 being physically abused by Resident 2. Resident 1 sustained right eye injury after being struck in the face, requiring emergency transfer to a General Acute Care Hospital (GACH). […]