Westminster Village North

In the surveyor’s words

From the most serious findings on record at Westminster Village North, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF628Nov 24, 2025

  Based on interview and record review, the facility failed to ensure written discharge and bed hold information was provided directly to the resident and the resident's representative upon transfer for 4 of 5 residents reviewed for hospitalization. (Resident 7, 13, 1 and 4)Findings include: 1. The clinical record for Resident 7 was reviewed on 11/18/25 at 3:16 p.m. The diagnoses included, but were not limited to, chronic obstructive pulmonary disease, major depressive disorder, anxiety disorder, personality disorder, mild neurocognitive disorder, spinal stenosis, dysphagia, hypertensive heart disease with heart failure, congestive heart failure, and type 2 diabetes mellitus. a. A progress note, dated 9/28/25 at 2:31 p.m., indicated Resident 7 was sent to the hospital. […]

• No harm, potential for more than minimal, patternF550Jul 18, 2024

  Based on interview and record review the facility failed to assure residents were treated with dignity and respect for 3 of 9 residents interviewed during Resident Council and 2 of 2 residents reviewed for dignity. (Resident B, P, 52, N, and K) Findings include: 1. The clinical record for Resident N was reviewed on 7/11/24 at 10:04 a.m. The diagnoses included, but were not limited to, unspecified injury of the cervical spinal cord and diabetes. A Significant Change of Status MDS (Minimum Data Set) Assessment, dated 4/8/24, indicated she was cognitively intact. […]

• No harm, potential for more than minimal, patternF565Jul 18, 2024

  Based on observation, interview, and record review, the facility failed to promptly act on a resident council grievance about tablecloths in the dining room. This had the potential to affect 9 of 123 residents who attend resident council. Findings include: On 7/11/24 at 1:24 p.m., the ADM (Administrator) provided the resident council minutes for April, May, and June 2024. The Resident Council Minutes, dated April 11, 2024, indicated that Resident 52 did not like the tablecloths removed from the dining rooms and the Administrator (ADM) had encouraged her to give the changes of the dining room experience a chance. A Resident Council meeting was held on 7/11/24 at 2:30 p.m. There were 9 residents in attendance. […]

• No harm, potential for more than minimal, patternF585Jul 18, 2024

  Based on interview and record review, the facility failed to timely address resident grievances, provide dates that grievances were resolved, provide dates that follow up was done with the individual who brought forward the grievance, indicate that grievances were confirmed or not confirmed, and to provide a means for residents to file a grievance anonymously for 7 of 7 grievances reviewed. (Residents N, P, and R) Findings include: 1. The clinical record for Resident N was reviewed on 7/11/24 at 10:04 a.m. The diagnoses included, but were not limited to, unspecified injury of the cervical spinal cord and diabetes. A Significant Change of Status MDS (Minimum Data Set) Assessment, dated 4/8/24, indicated she was cognitively intact. […]

• No harm, potential for more than minimal, patternF689Jul 18, 2024

  Based on observation, interview, and record review, the facility failed to ensure incident reports were completed after each fall event, post fall assessments were completed on every shift (morning, evening, and night) for 72 hours, and fall interventions were in place for 5 of 8 residents reviewed for accidents. (Residents E, C, F, M, and D) Findings include: 1. The clinical record for Resident E was reviewed on 7/12/24 at 10:30 a.m. The diagnoses included, but was not limited to, dementia and a displaced comminuted (broken in at least two places) fracture of the right femur. […]