Not rated by CMS — ratings are suppressed for new or low-volume facilities.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Rehabilitation Center Of Allison during CMS and state inspections, most recent first.
Two residents were not treated with dignity and respect when their personal care and environmental preferences were disregarded. One resident, who preferred to be clean shaven, was left unshaven for several days despite repeated requests and care plan documentation. Another resident's request to have her room cleaned at a different time and to keep the light off while watching a movie was ignored by housekeeping staff, who continued cleaning and turned the light back on. Staff interviews confirmed awareness of resident rights, but these were not upheld in practice.
A staff member alleged to have potentially abused a resident was not removed from contact with other residents after the incident. Instead, the staff member continued to clean multiple occupied rooms without supervision, contrary to facility policy requiring immediate separation of employees accused of abuse from all residents during an investigation.
A resident with intact cognition and independence in self-care reported being pushed by a housekeeper. An LPN assessed the resident and notified supervisory staff, but the housekeeper was not immediately removed from contact with other residents. The facility's investigation lacked interviews with other residents and staff present at the time, and did not document whether the accused staff member had further contact with residents.
The facility did not have an RN on duty for the required eight consecutive hours on one day, as confirmed by the DON. This deficiency was identified through a review of schedules, time cards, and staff interviews, with the facility having a census of 40 residents.
The facility failed to implement care plans for two residents, leading to deficiencies in their care. A resident requiring a lift device for transfers was instead moved with a gait belt by two staff members, as confirmed by the DON. Another resident, who needed a mechanical lift for transfers, was found on the floor and assisted back to bed by three staff using a gait belt, contrary to her care plan.
A resident's electronic health records were inaccurately documented due to a staff member altering medication counts and forging another LPN's signature for Lorazepam administration. The facility's policy required reporting discrepancies and initiating new forms, which were not followed, leading to the deficiency.
A resident with severe cognitive impairment and diabetes did not receive insulin according to the manufacturer's instructions. An LPN failed to prime the insulin pen and did not keep it in place for the required time after administration. The DON acknowledged these failures, and the facility lacked specific policies for insulin administration.
A facility failed to complete required pre and post dialysis assessments for a resident with stage 5 chronic kidney disease. Despite physician's orders and a care plan outlining necessary monitoring and reporting, multiple instances of incomplete assessments were identified. The DON acknowledged the inconsistency, and the facility lacked a specific dialysis care policy.
The facility failed to follow proper food handling protocols, with staff observed touching the drinking rims of glasses and not covering desserts during transport. The facility also lacked a policy on dining or food handling.
A resident received an incorrect dose of Lisinopril for 18 days due to a failure to update the medication order and lack of a policy on medication administration. The LPN confirmed the error, and the DON acknowledged the oversight.
Failure to Honor Resident Dignity and Preferences in Care and Environment
Penalty
Summary
The facility failed to honor the dignity and personal preferences of two residents regarding their care and environment. One resident, who historically preferred to be clean shaven as documented in his care plan, was observed over multiple days with significant facial hair growth. Despite expressing his desire to be shaved during his scheduled shower, the CNA did not perform the shave, and the resident remained unshaven for several days. Staff interviews confirmed that male residents should be asked daily about shaving preferences, and the resident himself reported requesting a shave that was not provided, even though he had his own razor and was told the facility would supply one. Another resident, with intact cognition and a history of verbal aggression, experienced a lack of respect for her preferences during a room cleaning. The resident requested that the light be turned off while she watched a movie and asked the housekeeper to return later. The housekeeper, however, continued cleaning and turned the light back on despite the resident's objections. Staff interviews revealed that the housekeeper was aware of resident rights and abuse prevention training, and the housekeeping supervisor acknowledged that cleaning should be rescheduled if a resident requests it. These incidents demonstrate that the facility did not consistently ensure residents were treated with dignity and respect, as required. Both residents' preferences and care plans were not followed, and staff did not adequately respond to their requests, resulting in a failure to uphold their rights to self-determination and a dignified existence.
Failure to Prevent Staff Accused of Abuse from Resident Contact
Penalty
Summary
The facility failed to prevent a staff member who was alleged to have potentially abused a resident from having contact with other residents. The incident involved a resident with intact cognition and several medical diagnoses, who became involved in a confrontation with a housekeeper. The resident reported that the housekeeper insisted on cleaning the room and turning on the lights despite the resident's wishes, leading to a physical interaction where the resident reached over the staff member to turn off the light and the staff member raised her hands. Both parties acknowledged physical contact, but no injuries were observed or reported. Following the incident, the nurse on duty was paged and responded to the resident's room, assessed the situation, and provided emotional support. The housekeeper was directed to leave the resident's room but was not removed from the facility or prevented from entering other resident rooms. The housekeeper continued to clean approximately 18 other rooms, most of which were occupied by residents, without supervision or restriction. Interviews with staff confirmed that while the staff member was separated from the resident involved in the incident, she was not separated from other residents as required by facility policy. The policy mandates that any employee accused of abuse should be immediately separated from all residents to prevent further potential abuse while an investigation is conducted. The failure to implement this policy resulted in the staff member having unsupervised access to other residents after the allegation was made.
Failure to Thoroughly Investigate Alleged Abuse Incident
Penalty
Summary
The facility failed to thoroughly investigate an allegation of abuse involving a resident who reported being pushed by a housekeeper. The resident, who was cognitively intact and largely independent in self-care, reported the incident to an LPN, who assessed the resident and found no injuries. The LPN notified the nurse manager and the Administrator, and the housekeeper was removed from the immediate situation. However, the housekeeper was allowed to finish her shift and leave the facility, and there was no documentation that the housekeeper was prevented from having further contact with other residents following the allegation. The facility's investigation was incomplete, lacking interviews with other residents and staff who were present on the date of the incident. There was no documentation to determine if other residents may have been affected or if the accused staff member had additional contact with residents. The investigation report included only two staff statements and did not include statements from all relevant personnel. The Administrator acknowledged that no other residents were interviewed as part of the investigation, and only a limited number of staff were spoken to, despite directions to obtain written statements from everyone involved.
Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide a Registered Nurse (RN) for eight consecutive hours on February 8, 2025, as required by Federal Regulations. This deficiency was identified through a review of the facility's schedule, time cards, staff interviews, and policy documents. The Director of Nursing (DON) confirmed during an interview that February 8 was the only day without the required RN coverage. The facility had a census of 40 residents at the time of the deficiency.
Failure to Implement Care Plans for Residents
Penalty
Summary
The facility failed to implement care plans for two residents, leading to deficiencies in their care. Resident #1, who required assistance with activities of daily living (ADLs) due to cognitive impairment and used a wheelchair, was observed being transferred from her wheelchair to her bed with the assistance of two staff members and a gait belt, but without the required lift device. This was confirmed by the Director of Nursing (DON) who was present during the transfer. Resident #2, who also required assistance with ADLs due to impaired cognition and weakness, was found on the floor and was assisted back to bed by three staff members using a gait belt, instead of the mechanical lift device specified in her care plan. An incident report documented this event, indicating a failure to follow the care plan for functional transfers.
Medication Documentation and Signature Forgery
Penalty
Summary
The facility failed to provide complete and accurately documented electronic health records for a resident, as evidenced by discrepancies in the Controlled Medication Utilization Record form. The form, dated 9/30/24, indicated the receipt of 60 Lorazepam/Ativan 0.25 mg tablets, which were 30 - 0.5 mg tablets cut in half by the pharmacy. The order was to administer twice daily and one by mouth every 12 hours as needed. An unknown staff member altered the quantity received from 30 to 60 1/2 tablets without signing and dating the change. Additionally, the form included an entry that a Lorazepam pill was administered by a staff member whose signature was forged by another staff member. Interviews revealed that Staff A, an LPN, admitted to altering the medication count and forging the signature of Staff B, another LPN, for the administration of Lorazepam. The Director of Nursing confirmed the signature discrepancy, and Staff B confirmed the forgery. The facility's Controlled Medications policy required discrepancies to be reported to the pharmacy, DON, and/or Administrator, and a new form to be initiated if the pharmacy did not provide a controlled substance flow sheet. However, these procedures were not followed, leading to the deficiency in documentation and medication administration.
Failure to Administer Insulin According to Manufacturer's Instructions
Penalty
Summary
The facility failed to administer insulin according to the manufacturer's recommendations for a resident with severe cognitive impairment and a diagnosis of diabetes mellitus. The resident was prescribed to receive 6 units of insulin Aspart solution subcutaneously three times a day. During an observation, a Licensed Practical Nurse (LPN) prepared the insulin pen for the resident but did not prime the pen as required by the manufacturer's instructions. The LPN administered the insulin without priming, which could lead to air being injected instead of the correct dose. Additionally, the LPN did not follow the manufacturer's instructions to keep the insulin pen in place for at least 6 seconds after administration to ensure the full dose was delivered. The Director of Nursing (DON) acknowledged these failures during an interview. The facility did not have specific policies related to medication or insulin administration, relying instead on professional nursing standards.
Failure to Complete Dialysis Assessments
Penalty
Summary
The facility failed to complete pre and post dialysis assessments for a resident with stage 5 chronic kidney disease who required dialysis. The resident, unable to complete a mental status assessment, had been receiving dialysis while residing at the facility. Physician's orders required staff to conduct dialysis assessments before and after dialysis sessions on specific days, as well as daily evaluations on non-dialysis days. However, a review of the clinical records revealed multiple instances where these assessments were not completed as directed. The care plan for the resident included specific instructions for monitoring and reporting any signs or symptoms of complications from dialysis, as well as care for the dialysis site. Despite these directives, the facility's records showed numerous dates where either pre or post dialysis assessments, or both, were not conducted. During an interview, the Director of Nursing acknowledged the inconsistency in completing the required assessments. Additionally, the facility lacked a specific policy for dialysis care, as revealed by the Administrator.
Improper Food Handling and Transport
Penalty
Summary
The facility failed to adhere to proper food handling protocols during meal service, as observed on multiple occasions. Staff members, including a Registered Nurse, Dietary Aide, Certified Nursing Aide (CNA), and Certified Medication Aide, were seen handling glasses by the drinking rim surface while serving 14 residents in the dining area. Additionally, desserts were not properly covered during transport to resident rooms, with two desserts partially covered and one not covered at all. The facility lacked a policy on dining or food handling, as confirmed by the Administrator and the Food Service Supervisor, who stated that staff were expected not to touch the food on plates or bowls and to cover all items on trays for in-room dining. Further observations revealed that a door greeter and a cook also handled cups by the drinking rim surface while serving residents. A CNA was seen serving a coffee cup by placing their palm over the open surface of the cup, with all fingers and thumb on the drinking surface. Another staff member served two cups in a similar manner. Additionally, a room tray delivered to a resident had milk and dessert that were not covered during transport from the dining room to the resident's room.
Medication Administration Error
Penalty
Summary
The facility failed to administer the appropriate dose of medication to a resident, leading to a medication error. Resident #17, who had no cognitive impairment and was diagnosed with hypertension, heart failure, coronary artery disease, cardiomyopathy, and intellectual disabilities, was observed receiving a 10 mg tablet of Lisinopril instead of the prescribed 5 mg dose. This error occurred despite the physician's order to decrease the dose due to low blood pressure. The resident's care plan also lacked direction for monitoring signs and symptoms of hypotension and medication side effects. Staff E, an LPN, confirmed administering the incorrect dose for 18 consecutive days, from 3/9 to 3/26. The error was acknowledged by the Director of Nursing (DON), who noted that the fax to the pharmacy for the new dose was never sent. The DON also explained that staff are expected to double-check the resident's name, order, MAR, and medication card before passing medications. The facility lacked a policy on medication administration, which contributed to the oversight.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Allison
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Clarksville Skilled Nursing & Rehab Center | 6.7 mi | — | 2 | 0 |
| Ams Memorial-greene | 9.4 mi | — | 0 | 0 |
| Shell Rock Senior Living | 11.9 mi | — | 0 | 0 |
| Maple Manor Village | 12.5 mi | — | 7 | 0 |
| Woodland Terrace | 15.7 mi | — | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.