Violet Springs Health Campus

In the surveyor’s words

From the most serious findings on record at Violet Springs Health Campus, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Mar 12, 2024

  THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on closed medical record review, review of emergency medical services (EMS) records, review of hospital records, review of video footage, interviews with facility staff, the coroner, law enforcement and restaurant owner, and review of facility policy, the facility failed to ensure Resident #51 was provided a safe environment, adequate supervision and assistance during an outing to prevent a fall down a flight of stairs. […]

• Actual harm, isolatedF684Jun 12, 2025

  Based on closed medical record review, hospital record review, review of an Emergency Medical Services (EMS) run report, staff interview, and facility policy review, the facility failed to timely and adequately identify an acute change in medical condition resulting in a delay in medical intervention/hospital care for Resident #54 resulting in the resident being found unresponsive and requiring cardiopulmonary resuscitation (CPR). Actual harm occurred beginning during the night shift on [DATE] when staff failed to identify an acute change in Resident #54's condition to ensure timely and adequate medical intervention was provided. At 6:00 A.M. Resident #54 sustained an unwitnessed fall. Resident #54 had an emesis (vomiting) and voiced complaints of not feeling well. […]

• No harm, potential for more than minimal, widespreadF730Oct 17, 2024

  Based on employee file review and staff interview, the facility failed to ensure State tested Nursing Assistants (STNAs) received annual performance reviews. This had the potential to affect all residents residing in the facility. The facility census was 46 residents. Findings Include: Review of STNA #139's employee file revealed a date of hire of 05/30/23. STNA #139's file contained a 90-day evaluation dated 11/10/23. STNA #139's file did not include an annual performance appraisal as of 10/17/24. Interview on 10/17/24 at 10:25 A.M. with Business Office Staff (BOS) #136 confirmed there was no annual evaluation present in the employee file for STNA #139. BOS #136 stated they were not required to do evaluations after the 90-day evaluation. Interview on 10/17/24 at 12:00 P.M. […]

• No harm, potential for more than minimal, widespreadF947Oct 17, 2024

  Based on record review and staff interview, the facility failed to ensure State tested Nurse Aides (STNAs) completed the minimum required 12 hours of in-servicing a year. This affected one (STNA #139) of two STNAs reviewed for required in-services. This had the potential to affect all residents in the facility. The facility census was 46. Findings Include: Review of STNA #139's personnel record revealed a hire date of 05/30/23. The record revealed STNA #139 completed six hours of training as a new hire in orientation. STNA #139 was assigned 12 hours of inservice/ on-line training that had not been completed. […]

• No harm, potential for more than minimal, widespreadF880May 17, 2021

  Based on observation, record review, interview, and review of facility policy the facility failed to maintain adequate infection control practices. This had the potential to affect all 42 residents currently residing in the facility. Findings include: 1. Observation on 05/10/21 at 10:35 A.M. and 11:10 A.M. revealed no staff member at the unlocked entrance of the building to screen visitors, no observed screening instructions, and no available staff within eye sight. One surveyor went to find a staff member while the other waited until a staff person from dietary walked by for assistance with the screening procedure which took place 15 minutes after entering the building. Interview on 05/13/21 at 8:44 A.M. […]