Wellpark Health and Rehabilitation

In the surveyor’s words

From the most serious findings on record at Wellpark Health and Rehabilitation, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF851May 1, 2026

  Based on interview and facility document review, the facility failed to electronically submit an accurate Payroll-Based Journal (PBJ) (staffing information for all employees in the nursing home based on payroll data submitted on a quarterly schedule) timely to the Centers for Medicare and Medicaid Services (CMS) for 1 (first quarter) 1 quarter reviewed for fiscal year 2026.Findings included: The facility's PBJ Staffing Data Report for the first quarter (October 1 through December 31) fiscal year 2026 indicated the facility failed to submit the PBJ report for the quarter. […]

• No harm, potential for more than minimal, patternF583May 1, 2026

  Based on observation, interview, facility document and policy review, the facility failed to protect residents' personal information for 2 (halls 100 and 400) of 4 halls. Findings included: A facility policy titled, HIPAA Compliance Policy and Procedure, last reviewed in 01/2026, indicated, All staff, volunteers, and vendors must not disclose any medical information about a resident, either, verbally, written, or electronically. An observation on 04/28/2026 at 4:32 AM revealed a phlebotomist approached the nurses' station, opened a laboratory binder, and obtained a piece of paper. The phlebotomist left the laboratory binder open on top of the nurses' station when he walked away to start to obtain the venipunctures (blood draws). […]

• No harm, potential for more than minimal, isolatedF656May 1, 2026

  Based on interview, record review, and facility policy review, the facility failed to develop a care plan to address the use of an anticoagulant for 1 (Resident #59) of 2 residents reviewed for care plan concerns. Findings included: A facility policy titled, Comprehensive Person-Centered Care Planning, reviewed in 01/2026, indicated, It is the policy of this facility that the interdisciplinary team (IDT) shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychological needs that are identified in the comprehensive assessment. […]

• No harm, potential for more than minimal, isolatedF695May 1, 2026

  Based on interview, record review, and facility policy review, the facility failed to ensure a physician order was in place for a non-invasive mechanical CPAP (Continuous Positive Airway Pressure) ventilator for 1 (Resident #66) of 2 residents reviewed for respiratory care. Findings included: A facility policy titled, Physician Orders, reviewed in 01/2026, indicated, It is the policy of this facility to accurately implement orders in addition to medication orders (treatment, procedures) only upon the order of a person duly licensed and authorized to do so in accordance with the resident's plan of care. A Face Sheet revealed the facility admitted Resident #66 to the facility on [DATE]. […]

• No harm, potential for more than minimal, isolatedF842May 1, 2026

  Based on interview, record review, and facility policy review, the facility failed to ensure the correct resident's name was used in a comprehensive care plan for 1 (Resident #59) of 18 residents reviewed for care plans. Findings included: A facility policy titled, Documentation and Charting, dated 01/2026, indicated, It is the policy of this facility to provide, and 5. Assistant in the development of a Plan of Care for each resident. A Face Sheet revealed the facility admitted Resident #59 on 08/06/2025. A 5-day Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 08/12/2025, revealed Resident #59 had a Brief Interview for Mental Status (BIMS) score of 14, which indicated the resident had intact cognition. […]