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 Seminary Manor during CMS and state inspections, most recent first.
A resident with multiple medical conditions, including acute respiratory failure with hypoxia, PVD, GAD, and BPH, reported that a CNA roughly handled his genital area while placing a urinal, yelled at him to use it despite his objections, and reacted angrily when urine spilled on him and the bed, leaving him feeling blindsided, dumbfounded, concerned, and embarrassed. The facility’s abuse policy required protection from abuse, interviews with involved parties including the resident when able, and documentation of the resident’s condition after an alleged incident, but the resident’s care plan contained no psychosocial interventions, and there was no documented follow-up assessment or care plan revision addressing his psychosocial well-being. Multiple staff, including the ADON, Social Services, and an LPN, acknowledged they had not specifically spoken with the resident about the incident or his feelings, and leadership confirmed there was no documentation of attempts to speak with him about the event.
The facility failed to follow its abuse reporting policy when an allegation that a resident had been roughly handled by a third-shift CNA was not immediately reported to the Administrator/Abuse Coordinator. One resident told his roommate he had been treated roughly and mishandled with a urinal; the upset roommate then reported this to a CNA, who in turn informed an LPN. The CNA and LPN acknowledged awareness of a complaint involving third-shift staff but did not directly notify the Administrator, and Social Services was only told that the resident had a complaint, without mention of abuse. Social Services made unsuccessful attempts to speak with the resident and did not learn the concern involved abuse until the resident’s son later stated it was "elder abuse." The Administrator reported first learning of the allegation hours after staff initially became aware, and the resident stated no one from the facility had come to talk with him about what occurred.
The facility failed to follow its abuse prohibition and reporting policy by not interviewing a resident who was the subject of an abuse allegation and not documenting any attempt to do so. Policy required interviews with all involved parties, including the allegedly abused resident when cognitively able, and documentation of the incident in the medical record. Instead, staff spoke with the resident’s son and another resident, but there was no record of direct contact with the affected resident. The DON and another facility representative confirmed that neither the investigation file nor the resident’s EMR contained evidence of an interview or attempted interview with the resident regarding the alleged abuse.
A resident with a history of behavioral symptoms and moderate cognitive impairment made sexually explicit comments to another cognitively impaired resident in a dining room, telling her he wanted to see and touch her breasts and making other graphic remarks. The recipient of the comments became upset, sought out staff, and reported the incident, stating she did not want other female residents to be similarly harassed and now actively avoids the other resident. Staff confirmed both residents were oriented, and the facility’s own policy prohibits sexual abuse, including sexual harassment, yet the incident was not substantiated as abuse based on a conclusion that the offending resident lacked capacity, despite acknowledgment that he understood basic social rules and could recognize inappropriate comments.
The facility did not return trust fund balances to discharged or deceased residents within the required timeframe and failed to notify residents or their representatives when trust fund accounts approached or exceeded the SSI resource limit. Multiple residents were affected, with some accounts holding significant balances, and staff confirmed that required notifications and refunds were not completed as per policy.
The facility did not hold required quarterly QAA meetings as outlined in its QAPI Plan, with only two meetings documented in the past year and none during the administrator's absence. This failure potentially affected all 97 residents in the facility.
The facility did not properly identify, monitor, or review antibiotic use for several residents, as required by its infection control and antibiotic stewardship policies. Antibiotics and antifungals were administered for various conditions, but the facility's tracking logs and pharmacist reviews failed to document the medications, their indications, or relevant test results. Staff interviews confirmed that ongoing monitoring and accurate record-keeping were not performed.
A resident had an active PRN order for Alprazolam 0.5 mg for generalized anxiety, despite not having received the medication for over a month. The DON confirmed that the order remained in the medical record and should have been discontinued according to facility policy.
A resident's care plan did not include their diagnoses of Atrial Fibrillation and Diabetes or the use of Eliquis and Humalog Insulin, despite these medications being ordered and administered. The Care Plan Coordinator confirmed these omissions during the review.
A resident did not have compression stockings applied as ordered by their physician. Although the treatment record indicated the stockings were on, observation revealed the resident was not wearing them, and a CNA confirmed the omission and located the stockings in the resident's dresser drawer.
A resident with a history of trauma and multiple psychiatric diagnoses did not have potential trauma triggers or emotional support needs identified in their care plan or medical record. Staff confirmed the absence of this documentation, and the facility lacked a trauma-informed care policy.
Two residents developed severe pressure ulcers due to the facility's failure to implement and update care plans with pressure-relieving interventions. One resident developed an unstageable ulcer on the left heel, while another developed a stage three ulcer on the right heel and an unstageable ulcer on the inner ankle. The facility did not conduct required assessments, update care plans, or notify physicians of changes, resulting in severe pain for the residents.
A resident with Congestive Heart Failure and respiratory conditions experienced multiple instances of oxygen deprivation due to the facility's failure to monitor and maintain a continuous oxygen supply. The resident's portable oxygen tanks were not adequately checked or refilled, leading to severe respiratory distress during a medical appointment and at the facility. Interviews revealed issues with equipment maintenance and a lack of proper procedures, contributing to the resident's distress.
The facility failed to change nebulizer and oxygen equipment as per protocol, with two residents' nebulizer equipment not replaced weekly and found un-bagged, and oxygen tubing for two residents not dated or replaced every seven days. Observations showed oxygen equipment improperly stored and dated, indicating a lapse in respiratory care standards.
The facility failed to disinfect wound care supplies after each use, affecting multiple residents. A resident with diabetes and chronic kidney disease received wound care, but the spray bottle used was not disinfected before being returned to the treatment cart. This bottle was used for multiple residents, contradicting the facility's infection control policies.
The facility failed to document justification for duplicative antidepressant therapy for a resident and for reinstating an antipsychotic for another. One resident was put back on Olanzapine after confirmed agitation, but without documented justification. Another resident was on three antidepressants without documented rationale, despite not being a harm to themselves or others.
Failure to Prevent Mental Abuse and Assess Psychosocial Impact After Alleged Rough Handling by CNA
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from mental abuse and to follow its own abuse prohibition and reporting policy. The facility’s policy, revised 11/28/19, requires protection from all forms of abuse, staff awareness and correction of inappropriate behaviors such as derogatory language and rough handling, immediate reporting of alleged abuse, interviews with involved parties including the resident when cognitively able, and documentation in the medical record of the nature and extent of any injuries or conditions resulting from the incident. The resident’s care plan contained no documentation regarding psychosocial well-being or related interventions. The resident, admitted with diagnoses including acute respiratory failure with hypoxia, peripheral vascular disease, generalized anxiety disorder, and benign prostatic hyperplasia, reported that early one morning he activated his call light to use the bathroom. A CNA entered, obtained a bedside urinal, and threw it at his groin, then grabbed his penis and pushed it toward the urinal while yelling, “it’s in, go!” The resident stated he told the CNA that his penis was not in the urinal, but she again yelled, “It’s in, use it!” He then urinated and felt urine go all over himself and the bed. He reported that the CNA appeared unhappy about the mess, forcefully closed the curtain between his bed and his roommate’s, and forcefully sat him on the side of the bed. A second CNA entered, observed the first CNA’s anger about the mess, and told the first CNA she would clean it up, after which the first CNA left the room. The resident described feeling blindsided, dumbfounded, concerned, and embarrassed by the incident. Following the incident, there was no documented assessment or care plan revision addressing the resident’s psychosocial well-being related to the alleged abuse. The resident stated that no one from the facility had come to talk to him about what occurred, although they had spoken with his son and another resident. The ADON, Social Service Director, and Social Service/Admission Director each acknowledged they had not spoken with the resident about the incident or his well-being, and the LPN stated she had not discussed anything specific related to the incident with him. The DON confirmed that the resident’s care plan had not been revised to address psychosocial needs after the incident, and the Administrator verified there was no documentation in the medical record or investigation showing attempts to speak with the resident. The Administrator stated he did not see any reason to follow up on the resident’s psychosocial well-being and attributed the resident’s reluctance to talk with staff to potential litigation rather than distress.
Failure to Immediately Report and Investigate Alleged Abuse
Penalty
Summary
The deficiency involves the facility’s failure to follow its Abuse Prohibition and Reporting policy by not immediately reporting an allegation of abuse involving one resident (R1) to the Abuse Coordinator/Administrator. The facility’s written policy requires any employee or agent who becomes aware of alleged abuse or neglect to immediately report the matter to the Administrator or designee, and specifies that staff must report whenever they hear the word "abuse" or suspect abuse. R1’s face sheet shows he was admitted with diagnoses including acute respiratory failure with hypoxia, peripheral vascular disease, generalized anxiety disorder, and benign prostatic hyperplasia. Despite this policy, multiple staff members became aware that R1 allegedly experienced rough handling by a third-shift CNA but did not promptly notify the Administrator as required. On the morning of 4/15/26, R2 reported to a CNA (V8) that he believed his roommate, R1, had been abused by a third-shift CNA, describing that there were two CNAs, one nice and one not, and that the rough CNA had been very rough with R1 and did something involving a urinal. V8 acknowledged that R2 appeared upset and that she understood this as a concern about possible abuse of R1 by third shift. V8 then reported the concern to an LPN (V6) and accompanied her to the residents’ room. V6 spoke briefly with R1, who stated he had a complaint about a third-shift CNA, and V6 told him she would get Social Services so he would not have to repeat himself. V8 stated she did not know who the Abuse Coordinator was and did not report the allegation to the Administrator. V6 stated she contacted Social Services (V5) only to report that R1 had a complaint, without specifying that it involved alleged abuse. Social Services (V5) reported being told only that R1 had a complaint and made two unsuccessful attempts to speak with him before R1’s son (V15) was brought to her office later that afternoon. V5 stated that the first time she became aware that the issue involved abuse was when V15 came in and stated, "This is Elder Abuse." V6 similarly stated she did not realize it was an abuse allegation until V15 used the term "elder abuse" when she took him to Social Services. The Administrator (V1), who is the Abuse Coordinator, reported that she did not become aware of the allegation until between 3:00 and 4:00 p.m. that day, despite the policy requiring immediate reporting to her when abuse is suspected. R1 stated that no one from the facility had come to talk to him about what occurred, although they had spoken with his son and his roommate. R1’s son also reported that he was not notified by the facility of the abuse allegation and instead learned of it from R1 and R2, and that when police later interviewed R1 and R2, R2 told the police he had reported the incident to the Administrator the morning it occurred. These interviews and record reviews demonstrate that the facility did not implement its abuse reporting procedures as written for this allegation involving R1.
Failure to Interview Resident During Abuse Allegation Investigation
Penalty
Summary
The facility failed to thoroughly investigate an allegation of abuse involving one resident. Facility policy titled "Abuse Prohibition and Reporting (Elder Justice Act)," revised 11/28/19, requires that all alleged abuse be immediately reported to administration, that interviews with all involved parties or potential witnesses be completed, and that statements be obtained from the resident abused or neglected if the cognitive level permits. The policy also requires documentation in the resident’s medical record of the nature and extent of any injuries or conditions resulting from the alleged incident, and related clinical notifications. Despite these requirements, the investigation documentation dated 4/15/26 and the resident’s electronic medical record contained no evidence that the resident was interviewed regarding the allegation of abuse reported on that date. The resident was admitted with diagnoses including acute respiratory failure with hypoxia, peripheral vascular disease, generalized anxiety disorder, and benign prostatic hyperplasia. On 4/24/26 at 3:00 p.m., the resident stated that no one from the facility had come to talk to him about what occurred, and that staff had spoken to his son and another resident instead. On 4/28/26, both the DON (V2) and another facility representative (V1) confirmed there was no documentation in the medical record or the investigation to show that the facility attempted to interview the resident about the alleged abuse. This lack of interview and documentation constituted the failure to respond appropriately to the alleged violation in accordance with facility policy.
Failure to Protect Resident From Sexual Harassment by Another Resident
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from sexual harassment by another resident, as required by its abuse prohibition policy. The facility’s policy, revised 11/28/19, states that residents must be protected from all forms of abuse, including sexual abuse and sexual harassment. One resident (R1) had a documented history and care plan problem area for multiple behavioral symptoms, including delusions, exit seeking, physical and verbal behaviors toward others, rejection of care, and making inappropriate comments toward female staff during care. R1’s cognitive status was documented as moderately impaired with a score of 10/15 on the MDS. Another resident (R2), with a cognitive score of 11/15 and no care plan problem areas indicating a history of making false allegations, reported that R1 made sexually explicit comments to her. On the morning of 1/8/26, R2 and R1 were both in the north dining room early, as R1 often went there for coffee and R2 had not been sleeping well and was also up early. R2 reported that R1 told her he wanted to see and touch her breasts in a sexual manner and made other graphic remarks. R2 stated she told R1 to stop talking to her that way, and he stopped immediately. R2 became upset, wheeled herself through the hallway looking for staff, and called out for help to report that R1 was making inappropriate comments and that she did not want other female residents to be harassed. Staff, including a CNA and an RN, responded to R2’s call, and R1 was escorted away from the area. During subsequent interviews, R2 consistently recalled the incident and reiterated that she was upset by R1’s comments and now makes a point to avoid him. Staff who knew both residents stated that both R1 and R2 were oriented to time, place, and purpose. The administrator later determined that the incident was not substantiated abuse based on a conclusion that R1 lacked capacity to understand his actions, despite also acknowledging that R1 understood basic social rules, could recognize that certain comments were inappropriate, and could follow simple directions or redirections. The facility’s determination that abuse was not substantiated, in the context of a credible report of sexually explicit comments and R1’s known history of inappropriate verbal behaviors, reflects the failure to ensure R2’s right to be free from sexual harassment by another resident.
Failure to Timely Refund Resident Trust Funds and Notify of SSI Resource Limit Exceedance
Penalty
Summary
The facility failed to return resident trust fund balances within the required 30-day period after discharge or death for 46 residents. Record review and interviews confirmed that multiple residents had remaining balances in their trust fund accounts that were not refunded in accordance with facility policy and state/federal regulations. Documentation showed that these balances ranged from small amounts to over a thousand dollars, and there was no evidence that the funds were returned to the residents or their representatives within the specified timeframe. The facility's own admission contract and trust fund policy require timely refunds, but these were not followed, as confirmed by both the administrator and business office staff. Additionally, the facility did not provide required notifications when resident trust fund balances approached or exceeded the Supplemental Security Income (SSI) resource limit. Three residents had trust fund balances that exceeded the SSI resource limit, but there was no documentation that the residents, their legal representatives, or social services were notified as required by facility policy. The business office manager was unaware of the SSI resource limit, and the administrator confirmed the lack of notification. These failures were identified through review of facility records and interviews with staff.
Failure to Hold Required Quarterly QAA Meetings
Penalty
Summary
The facility failed to conduct quarterly Quality Assessment and Assurance (QAA) meetings as required by its QAPI Plan, which specifies that the committee must meet on a quarterly basis. Record review showed that only two QAA sign-in sheets were available for the past year, dated March and April, with no documentation of meetings prior to March. The administrator confirmed that QAA meetings were not held during her temporary absence starting in July, and no additional sign-in sheets could be located. This lapse in holding required QAA meetings has the potential to affect all 97 residents residing in the facility, as documented on the CMS form 671.
Failure to Monitor and Review Antibiotic Use for Multiple Residents
Penalty
Summary
The facility failed to identify, monitor, and review antibiotic use for all five residents reviewed for antibiotic stewardship, as required by their Infection Control and Antibiotic Stewardship policies. The policies specify that the Infection Control Committee is responsible for surveillance, review, and analysis of infections, as well as maintaining a system for reporting and evaluating antibiotic use. However, the facility's Infection Tracking Logs for multiple months did not include required information such as the antibiotics administered, their indications for use, or the results of relevant cultures and laboratory tests for several residents who were receiving antibiotics or antifungals. For example, one resident was on a maintenance dose of Macrodantin for a history of urinary tract infections without a documented stop date, and this was not tracked in the Infection Tracking Log or evaluated by the pharmacist. Another resident received Macrobid prophylactically and later multiple courses of Levofloxacin for urinary tract infections, but the logs did not document the antibiotics, their indications, or the results of diagnostic tests. Additional residents received various antibiotics and antifungals for conditions such as cough, skin eruptions, pneumonia, and cystitis, but the facility failed to document these treatments and their appropriateness in both the Infection Tracking Log and the Pharmacist's Summary of Recommendations. Interviews with facility staff confirmed that ongoing monitoring of residents on prophylactic antibiotics was not performed after initial initiation, and that the tracking system was incomplete and inaccurate. The Assistant DON/Infection Preventionist acknowledged that the logs did not track culture or test results, were not comprehensive, and that the pharmacist's reviews were not inclusive of all antibiotic or antifungal use. The Administrator also stated that the facility struggled with entering and ensuring the accuracy of required infection information in the new tracking system.
Failure to Discontinue Unnecessary PRN Psychotropic Medication
Penalty
Summary
The facility failed to discontinue a PRN (as needed) psychotropic medication, Alprazolam 0.5 mg, for one resident as required by facility policy and procedures. The resident had an active physician order for Alprazolam to be administered twice daily as needed for generalized anxiety, with the last documented administration occurring over a month prior to the survey. Despite the lack of recent use, the medication order remained active in the resident's medical record. The Director of Nursing confirmed that the PRN order for Alprazolam was still present and acknowledged it should have been discontinued in accordance with facility protocols to prevent unnecessary medication use.
Care Plan Omission for Anticoagulant and Insulin Therapy
Penalty
Summary
The facility failed to develop a comprehensive care plan that addressed all of a resident's medical needs. Specifically, for one resident, the care plan did not include the diagnoses of Atrial Fibrillation and Diabetes, nor did it address the administration of Eliquis, a blood thinner, and Humalog Insulin, both of which were ordered by the physician and being administered according to the Medication Administration Record. The Care Plan Coordinator confirmed that these diagnoses and medications were missing from the resident's care plan and acknowledged the oversight during the surveyor's review.
Failure to Apply Compression Stockings as Ordered
Penalty
Summary
A deficiency occurred when a resident did not receive leg compression stockings as ordered by their physician. The physician's orders specified that Tubi Grips (compression stockings) were to be applied to both lower extremities in the morning and removed at bedtime. The resident's treatment administration record indicated that the Tubi Grips were on, but during an observation in the activity area, the resident was found without Tubi Grips, socks, or shoes. A certified nurse aide confirmed responsibility for applying the Tubi Grips, acknowledged that the resident was not wearing them, and verified that the stockings were available in the resident's dresser drawer but had not been applied as required.
Failure to Identify and Address Trauma Triggers in Resident Care Plan
Penalty
Summary
The facility failed to provide trauma-informed care for one resident with a history of significant trauma, including childhood separation, time in an orphanage, sexual assault, and experiencing a tornado. The resident's diagnoses included Generalized Anxiety Disorder, Psychotic Disturbance, Mood Disturbance, Major Depressive Disorder, and Hallucinations. Despite this history, the resident's social assessment and care plan did not identify or document any potential triggers or emotional support needs related to past trauma. Interviews with facility staff confirmed that the care plan and medical record lacked this information, and it was also noted that the facility did not have a policy on trauma-informed care.
Failure to Prevent and Treat Pressure Ulcers
Penalty
Summary
The facility failed to implement adequate pressure ulcer prevention and treatment protocols for two residents, R1 and R2, leading to the development and worsening of pressure ulcers. R1, who was admitted with a left femur fracture and other mobility issues, developed an unstageable pressure ulcer on the left heel six days after admission. The facility did not conduct weekly Braden Scale assessments as required, and R1's care plan was not updated to include interventions for the newly developed pressure ulcer. Additionally, R1's wound was incorrectly categorized as a stage one pressure injury, and there was a lack of consistent wound assessment and documentation. R2, who was severely cognitively impaired and diagnosed with chronic congestive heart failure and cerebrovascular disease, developed a stage three pressure ulcer on the right heel and an unstageable pressure ulcer on the inner ankle. The facility failed to update R2's care plan with pressure-relieving interventions after R2 was identified as high risk for pressure ulcers. Furthermore, there was inadequate documentation and notification to the physician regarding the condition and treatment of R2's pressure ulcers, resulting in severe pain for R2. The facility's staff, including the wound nurse and care plan coordinator, admitted to being behind on assessments and care plan updates. There was also a lack of communication with the physician regarding changes in the residents' wound conditions. These deficiencies highlight the facility's failure to adhere to its own pressure ulcer prevention and treatment protocols, leading to the development and worsening of pressure ulcers in residents R1 and R2.
Failure to Ensure Continuous Oxygen Supply for Resident
Penalty
Summary
The facility failed to adequately monitor and ensure a continuous supply of oxygen for a resident diagnosed with Congestive Heart Failure and other respiratory conditions. The resident, who was cognitively intact, was admitted with a need for continuous supplemental oxygen. However, the facility did not maintain the resident's oxygen supply as ordered by the physician, leading to multiple instances where the resident was without oxygen for significant periods. This resulted in the resident experiencing severe respiratory distress, including chest pain and shortness of breath. The report details specific incidents where the resident's portable oxygen tank ran out, both during a medical appointment and at the facility. During a visit to a nephrologist, the resident's oxygen tank was empty, causing the resident's oxygen saturation to drop to 80 percent, and the resident exhibited symptoms of cyanosis and slurred speech. The facility's transport staff was not adequately trained or equipped to handle the resident's oxygen needs, leading to a delay in providing a replacement tank. Another incident occurred during dinner at the facility, where the resident's oxygen tank again ran empty, and it took an extended period for staff to provide a new tank. Interviews with staff and family members revealed a lack of proper procedures and equipment maintenance, contributing to the resident's distress. The facility's oxygen tanks were reported to be old and unreliable, with some gauges not functioning correctly. Additionally, there was no consistent schedule for checking and refilling the oxygen tanks, and the resident's care plan did not address their oxygen needs. The facility's failure to ensure a continuous oxygen supply and perform necessary assessments after these incidents highlights significant deficiencies in the care provided to the resident.
Failure to Maintain Proper Respiratory Care Protocols
Penalty
Summary
The facility failed to adhere to its own protocols for respiratory care, specifically regarding the timely replacement and proper storage of nebulizer and oxygen equipment. For two residents, the nebulizer mask and tubing were not changed every seven days as required. One resident's nebulizer equipment was found on a nightstand, un-bagged, and dated over a month prior, while a registered nurse confirmed the equipment should be changed weekly and stored in a bag between uses. Additionally, the oxygen tubing for two residents was not replaced every seven days, as evidenced by the tubing being dated several months prior or having no date at all. Further observations revealed that oxygen tubing and nasal cannulas for two residents were found on the floor, connected to oxygen tanks, and running without proper dating. These residents were not present in their rooms at the time of observation, and when seen later, they were using oxygen tanks with tubing that also lacked date markings. These findings indicate a failure to maintain proper respiratory care protocols, potentially compromising the residents' health and safety.
Failure to Disinfect Wound Care Supplies
Penalty
Summary
The facility failed to ensure that wound care supplies were disinfected after each resident's wound care, which has the potential to affect multiple residents receiving wound care. The facility's Standard Precautions policy and Wound Care policy emphasize the importance of following standard precautions during wound care to prevent the transmission of infectious agents. However, during an observation, it was noted that the wound cleanser spray bottle used for a resident's wound care was not disinfected before being returned to the treatment cart. This spray bottle was used for multiple residents, which contradicts the facility's policy and increases the risk of cross-contamination. The deficiency was observed during the wound care of a resident with diagnoses including insulin-dependent diabetes and chronic kidney disease. The resident's treatment involved cleaning and dressing a pressure ulcer on the left buttock. After the wound care was completed, the wound nurse returned the spray bottle to the treatment cart without disinfecting it. The Director of Nurses confirmed that these bottles are considered community property and are used for multiple residents' wound care, further highlighting the facility's failure to adhere to its own infection control policies.
Deficiencies in Psychotropic Medication Management
Penalty
Summary
The facility failed to document justification for the use of duplicative antidepressant therapy for one resident and failed to document the justification for reinstating an antipsychotic for another resident. One resident was initially prescribed Olanzapine for dementia with delusions and agitation, but the medication was discontinued following a pharmacy review due to a lack of documented behaviors justifying its use. However, the resident was later put back on Olanzapine after exhibiting agitation and accusations of missing clothing, which were confirmed to be true events rather than delusions. Despite this, the facility did not document the justification for reinstating the antipsychotic medication. Another resident was prescribed three different antidepressants: Mirtazapine, Bupropion HCL, and Sertraline. The Director of Nursing, responsible for managing psychotropic medications, was unable to provide a documented reason for the resident taking multiple antidepressants, and it was confirmed that the resident was not a harm to themselves or others. This lack of documentation for the use of multiple antidepressants constitutes a deficiency in the facility's management of psychotropic medications.
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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 Galesburg
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Marigold Rehabilitation And Health Care Center | 0.1 mi | — | 6 | 2 |
| Allure Of Knox County | 1.5 mi | — | 2 | 1 |
| Allure Of Lake Storey | 1.6 mi | — | 1 | 0 |
| Allure Of Galesburg | 1.7 mi | — | 13 | 5 |
| Knox County Nursing Home | 5.8 mi | — | 0 | 0 |
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