Village Care of King

In the surveyor’s words

From the most serious findings on record at Village Care of King, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Jul 11, 2025

  Based on record review, and staff, family member, Resident, Physician Assistant, and Medical Director interviews, the facility failed to provide supervision for Resident #1 who had a diagnosis of dementia, an addiction to cigarettes, and required supervision/touching assistance for walking 10 feet. Resident #1 left the facility unnoticed and unattended, walking along the side of a 35 mile an hour two-lane road to obtain cigarettes at a nearby store. Resident #1 was located approximately 1/2 mile away from the facility standing in a grassy field near the side of the road. The walking route to where the resident was located included an upward sloping sidewalk, a downward sloping sidewalk with a pond to the left, and then a dirt path that ended at the edge of the grassy field. […]

• Immediate jeopardy, isolatedF660Mar 23, 2024

  Based on record review, resident, ombudsman, family, friend, staff, the Home Health Nurse, and Adult Protective Services Social Workers interviews the facility failed to develop and implement an effective discharge planning process for 1 of 3 residents, Resident #1, by not assessing the home environment which was described as not safe by the resident and family, discharging the resident to home where the resident did not have a functional phone to contact people or 911 in the event of an emergency and arranging for individuals who would be able to obtain the resident's prescription medications and assist with basic Activities of Daily Living (ADLs) such as transfer from the couch to a wheelchair, toileting, peri-care, meal preparation, and bathing. […]

• Immediate jeopardy, isolatedF689Jan 19, 2024

  Based on observation, record review and interview of staff, physician, resident, the facility failed to protect Resident #1 from rolling out of bed during the provision of personal care. Resident #1 fell from her bed to the floor. Resident #1 was sent to the emergency room and was diagnosed with a distal femur fracture (fractures of the thighbone that occur just above the knee joint) of both legs. The fractures resulted in hospitalization , treatment with Heparin (blood thinner) to prevent blood clots in the lower legs and Fentanyl (a controlled substance used to treat severe pain) for pain. […]

• Immediate jeopardy, isolatedF684Aug 9, 2022

  Based on record review, staff interviews, and physician interview the facility failed to have a nurse assess one (Resident #1) of three residents reviewed for assessment after injury. Resident #1 had her right leg pinched between the bed and the sit to stand lift during a transfer to the shower chair. Before reporting the injury to the nurse, Resident #1 was transferred to a shower chair, received a shower, and was transferred back to bed. Resident #1 experienced pain and was transferred to the hospital where she expired from complications with a traumatic right calf hematoma. Immediate Jeopardy began on [DATE] when Nurse aide (NA #8) was transferring Resident #1 and pinched her leg between the bed and the sit to stand lift causing pain. […]

• Immediate jeopardy, isolatedF689Aug 9, 2022

  Based on record review, staff interviews, and a Physician interview the facility failed to safely transfer from the bed to the shower chair one (Resident #1) of three residents reviewed for supervision during transfers. Resident #1 experienced pain and was transferred to the hospital where she expired from complications with a traumatic right calf hematoma. Immediate Jeopardy began on [DATE] when Nurse aide (NA #8) transferred Resident #1 from the bed to the shower chair pinching her leg between the bed and the sit to stand lift. NA #8 then sat Resident #1 back down on the bed using the sit to stand lift when the resident expressed pain. NA #8 used the sit to stand lift to transfer Resident #1 to the shower chair, gave her a shower, and returned her to her room. […]