Providence Health & Rehab Center

August 7, 2026 · Standard inspection · 30 citations

• Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  Risk of harm, no one hurt, widespread (level F)Nutrition and DietaryPlan to fix it accepted

• Provide and implement an infection prevention and control program.

  Risk of harm, no one hurt, a pattern (level E)Infection ControlPlan to fix it accepted

• Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

  Risk of harm, no one hurt, a pattern (level E)Resident RightsPlan to fix it accepted

• Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  Risk of harm, no one hurt, a pattern (level E)Quality of Life and CarePlan to fix it accepted

• Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

  Risk of harm, no one hurt, a pattern (level E)Pharmacy ServicePlan to fix it accepted

• Allow resident to participate in the development and implementation of his or her person-centered plan of care.

  Risk of harm, no one hurt, a pattern (level E)Resident RightsPlan to fix it accepted

• Implement a program that monitors antibiotic use.

  Risk of harm, no one hurt, a pattern (level E)Infection ControlPlan to fix it accepted

• Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

  Risk of harm, no one hurt, a pattern (level E)Resident RightsPlan to fix it accepted

• Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

  Risk of harm, no one hurt, a pattern (level E)Quality of Life and CarePlan to fix it accepted

• Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

  Risk of harm, no one hurt, a pattern (level E)Pharmacy ServicePlan to fix it accepted

• Develop and implement policies and procedures for flu and pneumonia vaccinations.

  Risk of harm, no one hurt, a pattern (level E)Infection ControlPlan to fix it accepted

• Observe each nurse aide's job performance and give regular training.

  Risk of harm, no one hurt, a pattern (level E)Nursing and Physician ServicesPlan to fix it accepted

• Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

  Risk of harm, no one hurt, a few residents (level D)AdministrationPlan to fix it accepted

• Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

  Risk of harm, no one hurt, a few residents (level D)Resident Assessment and Care PlanningPlan to fix it accepted

• Provide safe and appropriate respiratory care for a resident when needed.

  Risk of harm, no one hurt, a few residents (level D)Quality of Life and CarePlan to fix it accepted

• Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

  Risk of harm, no one hurt, a few residents (level D)AdministrationPlan to fix it accepted

• Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

  Risk of harm, no one hurt, a few residents (level D)Freedom from Abuse, Neglect, and ExploitationPlan to fix it accepted

• Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  Risk of harm, no one hurt, a few residents (level D)Quality of Life and CarePlan to fix it accepted

• Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

  Risk of harm, no one hurt, a few residents (level D)Resident RightsPlan to fix it accepted

• Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Risk of harm, no one hurt, a few residents (level D)Freedom from Abuse, Neglect, and ExploitationPlan to fix it accepted

• Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

  Risk of harm, no one hurt, a few residents (level D)AdministrationPlan to fix it accepted

• Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

  Risk of harm, no one hurt, a few residents (level D)Resident RightsPlan to fix it accepted

• Keep all essential equipment working safely.

  Risk of harm, no one hurt, a few residents (level D)EnvironmentalPlan to fix it accepted

• Keep residents' personal and medical records private and confidential.

  Risk of harm, no one hurt, a few residents (level D)Resident RightsPlan to fix it accepted

• Develop and implement policies and procedures to prevent abuse, neglect, and theft.

  Risk of harm, no one hurt, a few residents (level D)Freedom from Abuse, Neglect, and ExploitationPlan to fix it accepted

• Honor the resident's right to organize and participate in resident/family groups in the facility.

  Risk of harm, no one hurt, a few residents (level D)Resident RightsPlan to fix it accepted

• Ensure each resident receives an accurate assessment.

  Risk of harm, no one hurt, a few residents (level D)Resident Assessment and Care PlanningPlan to fix it accepted

• Provide for the safe, appropriate administration of IV fluids for a resident when needed.

  Risk of harm, no one hurt, a few residents (level D)Quality of Life and CarePlan to fix it accepted

• Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

  Risk of harm, no one hurt, a few residents (level D)Quality of Life and CarePlan to fix it accepted

• Reasonably accommodate the needs and preferences of each resident.

  Risk of harm, no one hurt, a few residents (level D)Resident RightsPlan to fix it accepted

July 9, 2026 · Complaint investigation · 3 citations

• Provide activities to meet all resident's needs.

  Risk of harm, no one hurt, a few residents (level D)Quality of Life and CareFrom a complaintPlan to fix it accepted

• Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

  Risk of harm, no one hurt, a few residents (level D)Resident Assessment and Care PlanningFrom a complaintPlan to fix it accepted

• Ensure that residents are fully informed and understand their health status, care and treatments.

  Risk of harm, no one hurt, a few residents (level D)Resident RightsFrom a complaintPlan to fix it accepted