Villa Vista Royale LLC

In the surveyor’s words

From the most serious findings on record at Villa Vista Royale LLC, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF727Oct 12, 2022

  Based on record review, facility policy and procedure review and interview the facility failed to use the services of a registered nurse (RN) for at least eight consecutive hours a day, seven days a week as required. This had the potential to affect all 42 residents residing in the facility. Findings include: Review of the facility assessment, dated 02/02/22 revealed no evidence of RN requirements, however the assessment revealed nursing was available 24 hours a day. Review of the staffing schedule, daily posting, and timecards dated 08/29/22 to 09/25/22 revealed there was no consecutive RN coverage for eight hours as required on 09/03/2, 09/10/22, or 09/11/22. Interview on 10/05/22 at 9:23 A.M. […]

• No harm, potential for more than minimal, widespreadF880Feb 11, 2021

  Based on observation, record review, facility policy review and interview the facility failed to maintain acceptable infection control practices including the cleaning of personal protective equipment (goggles/shield) to prevent the transmission of communicable diseases/infections including COVID-19. This affected one resident (#32) of one resident identified to be in airborne droplet isolation and had the potential to affect all 41 residents residing in the facility. Findings include: During the onsite survey, the facility identified only one resident in isolation. Resident #32 was a new admission in a 14 day quarantine to monitor for signs of COVID-19. […]

• No harm, potential for more than minimal, isolatedF644Feb 24, 2026

  Based on record review, interview and facility policy review, the facility failed to update a resident's Pre-admission Screening and Resident Review (PASARR) with changes to the resident medical diagnosis This deficient practice affected one resident (Resident #5) of one resident reviewed for PASARR. The facility census was 46.Findings Include: Review of Resident #5's medical record revealed an admission date of 07/01/24 with diagnoses including but not limited to high blood pressure, anxiety disorder, post traumatic stress disorder (PTSD), and history of falls.Review of Resident #5's physician orders revealed an order dated 04/01/25 for the antidepressant medication, Zoloft Oral Tablet 50 milligrams (mg). […]

• No harm, potential for more than minimal, isolatedF686Feb 24, 2026

  Based on record review, observation, interview, review of manufacturer operating guidelines, and facility policy review the facility failed to ensure pressure relieving interventions were appropriate based on resident weight and the location of the resident's pressure ulcer was accurately documented. This affected one resident (Resident #24) of two residents reviewed for pressure ulcers. The facility census was 46.Findings Include: Review of Resident #24's medical record revealed an admission date of 04/28/23 with diagnoses including but not limited to dysphagia, dementia, hypokalemia, depression disorder, and high blood pressure.Review of Resident #24's physician orders revealed an order dated 12/23/25 for an air mattress to the bed to prevent skin breakdown, check placement and function… […]

• No harm, potential for more than minimal, isolatedF684Apr 3, 2025

  Based on observation, interviews, record review, and policy review the facility failed to assess and monitor a resident's edema while having a sling and brace in place for a humerus fracture. This affected one resident (#249) of 24 resident records reviewed for assessments. Findings include: Review of record revealed Resident #249 was admitted to the facility on [DATE] with diagnoses including left humerus fracture, hypertension (HTN) atrial fibrillation, generalize anxiety disorder, major depressive disorder, Gastrointestinal reflux disease (GERD), type 2 diabetes, heart failure, cerebrovascular disease, hyperlipidemia, anemia, mitral stenosis, lymphedema, atherosclerotic heart disease, abnormal weight loss, Transient ischemic attack (TIA), breast cancer, hypothyroid, dry eyes,… […]