Westridge Health Care Center

In the surveyor’s words

From the most serious findings on record at Westridge Health Care Center, in the surveyor’s own words.

• Actual harm, isolatedF684Mar 19, 2026

  Based on interview, observation, and record review, the facility failed to ensure a resident's change in condition after a fall was assessed and treated which resulted in harm of a resident who had delayed treatment for a fractured right femur (thigh bone) that required surgery for 1 of 4 residents reviewed for accidents (Resident 8). Findings include:During an interview, on 3/15/26 at 1:33 p.m., Resident 8 indicated she had constant pain and recently had a fall and was hurt. Resident 8's record was reviewed on 3/17/26 at 11:56 a.m. […]

• Actual harm, isolatedF684Apr 13, 2022

  Based on interview and record review, the facility failed to ensure a timely intervention and accurate documentation were completed after an incident resulting in actual harm when a resident experienced pain and delayed surgical intervention for a fracture for 1 of 2 residents reviewed for accidents (Resident 41). Findings include: During an interview, on 4/6/22 at 1:59 p.m., Resident 41 indicated she used to sleep and receive all care in her Broda chair (a specialized tilting positioning chair). A few months ago, staff provided incontinence care in the Broda chair, she rolled over, and heard an audible pop. Immediately afterwards, she felt pain. There was an x-ray completed in the facility, but no fracture was found. The fracture was not found for 12 days. […]

• No harm, potential for more than minimal, widespreadF802Jan 30, 2026

  Based on record review, observation, and interview, the facility failed to ensure sufficient dietary support personnel was implemented per their facility assessment. This deficiency had the potential to affect 44 of 44 residents who receive food from the kitchen.Findings include:Review of a confidential statement, on 1/29/26 at 9:47 a.m., indicated the food was disgusting from the kitchen and the kitchen didn't have enough workers. During an observation during lunch meal service, on 1/29/26 at 12:07 p.m., there were two dietary staff members in the kitchen. There were a Dietary Manager (cook) and a Dietary Aide. The Dietary Manager was the only staff member plating the food for both the dining room and hall trays. […]

• No harm, potential for more than minimal, patternF657Mar 19, 2026

  Based on interview and record review, the facility failed to ensure residents and their representatives participated in care plan meetings (a documented meeting where a resident, their family, and a team of health professionals meet to discuss the resident's goals, preferences, and necessary care services), for 4 of 16 residents reviewed for care plan meetings (Residents 41, 40, 1, and 8). Findings include:1. During an interview, on 3/15/26 at 12:53 p.m., Resident 41's brother indicated he was the resident Power of Attorney (POA-a legal document that allows someone else to act on another individual's behalf) and responsible party. He indicated he attended a care plan meeting right after the resident was admitted but had not known about or attended a meeting since that time. […]

• No harm, potential for more than minimal, patternF657Jun 6, 2024

  Based on observation, record review, and interview, the facility failed to update care plans with post fall interventions for 4 of 6 residents reviewed for falls (Residents B, C, H, and K). Findings include: 1. On 6/6/24 at 2:30 p.m., observed Resident A sitting up in wheel chair she was propelling herself in the hall. She had both shoes and socks on. She had difficulty communicating related to aphasia. Bed alarm was on the bed under an incontinent pad. Chair alarm was not visible on the wheelchair. On 6/7/24 at 11:57 a.m., observed Resident A, sitting in wheelchair in the main dining room. A call alarm was on the wheelchair with the alarm device on the back of the chair. On 6/6/24 at 10:49 a.m., the medical record for Resident A was reviewed. […]