Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around February 2027
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 Bedford Care Center Of Marion during CMS and state inspections, most recent first.
A resident with hemiplegia required a full body lift with two-person assistance and a large sling for transfers. However, a CNA transferred the resident alone using an incorrect small sling, resulting in a fall and injuries. The CNA did not verify the sling size or check the Kardex, and the resident expressed distress during the transfer. Observations revealed continued use of the wrong sling size, and staff interviews confirmed non-compliance with the care plan and facility policies.
A resident with a history of hemiplegia and moderate cognitive impairment was injured during a transfer using a mechanical lift when a CNA performed the transfer alone and used an incorrect sling size. The resident fell, resulting in a fracture and head laceration. Facility policy required two staff members for such transfers and verification of the correct sling size, but these procedures were not followed.
The facility failed to address complaints from resident council members about cold food, as their grievances were not consistently documented or communicated. Despite efforts by the DON to ensure timely meal service, the issue persisted. The Assistant Dietary Manager was unaware of the complaints, and the Administrator believed the problem was resolved, as he had not received the meeting minutes. The residents involved had varying cognitive statuses, but their complaints were not effectively addressed.
A facility failed to serve food at an appetizing temperature, affecting a resident and potentially impacting 74 others. Observations revealed cold meal trays, and a resident expressed ongoing dissatisfaction with cold breakfasts. Delays in food service and the use of non-insulated carts contributed to the issue. The resident, with a history of Bipolar and Anxiety Disorders, was cognitively intact.
The facility failed to accurately complete MDS assessments for two residents who were discharged. One resident was incorrectly documented as being discharged to a LTC facility instead of an acute care hospital, while another was documented as going to a short-term hospital instead of a LTC facility. An LPN confirmed the errors, and the DON was informed of the inaccuracies.
A resident with visual impairment did not receive necessary prescription glasses due to financial constraints. The facility's Social Services Director provided inadequate over-the-counter glasses and did not seek alternative assistance or inform the Administrator. The Director of Nursing confirmed the prescription was not filled, and the Administrator was unaware of the situation, despite the facility's policy to provide medically-related social services.
The facility failed to maintain proper chemical sanitizer concentration in a low-temperature dishwasher, resulting in inadequately cleaned dishes. A dietary staff member observed dishes with food residue, and further investigation revealed the chlorine concentration was only 10 ppm, below the required 50 ppm. The issue was due to unprimed sanitation tubing after a new container was installed.
The facility failed to document the refusal of influenza and pneumococcal vaccines for two residents, as required by their policy. Despite the DON stating that the residents had refused the vaccines, there were no signed declination forms in their medical records. The RCC, responsible for maintaining these records, confirmed the absence of documentation.
The facility failed to document the refusal of the COVID-19 vaccine for two residents, as required by their policy. Despite the Director of Nursing, Administrator, and Resident Care Coordinator acknowledging the issue, there was no evidence in the medical records to indicate whether the residents had received or refused the vaccine.
Failure to Implement Comprehensive Care Plan for Resident Transfers
Penalty
Summary
The facility failed to implement comprehensive care plan interventions related to resident transfers, resulting in a significant incident involving a resident. The resident, who had been admitted with diagnoses including hemiplegia and hemiparesis following a cerebral infarction, required a full body lift with two-person assistance and a large sling for transfers. However, a Certified Nurse Aide (CNA) transferred the resident alone, using an incorrect small sling size, which led to the resident falling and sustaining a fracture and head laceration. The incident occurred when the CNA operated the lift without verifying the sling size and without assistance, despite the care plan specifying the need for two-person assistance. The CNA admitted to using the sling already attached to the lift and not checking the Kardex for the required sling size. The resident expressed distress during the transfer, indicating that something was not right, and subsequently experienced severe pain and required hospitalization. Further observations revealed that the incorrect sling size was used again during a later transfer, indicating a continued failure to adhere to the care plan. Interviews with staff, including the Licensed Practical Nurse (LPN) and the Administrator, confirmed that the facility's policy required two staff members to be present during lift transfers and that the care plan was not updated following the fall. The Administrator was unaware of the continued use of the wrong sling size, despite staff education on proper lift pad identification and the availability of sufficient lift pads.
Improper Use of Mechanical Lift Leads to Resident Injury
Penalty
Summary
The facility failed to ensure the safe transfer of a resident using a mechanical lift, resulting in a fall that caused a fracture and head laceration. The incident involved a Certified Nurse Aide (CNA) who performed the transfer alone without assistance and used an incorrect sling size. The facility's policy required two staff members to assist with transfers and to verify the correct sling size according to the resident's care plan. However, the CNA used a medium sling instead of the required large sling, leading to the resident sliding out of the sling and sustaining injuries. The resident involved in the incident had a history of hemiplegia and hemiparesis following a cerebral infarction, affecting the left non-dominant side, and was non-weight-bearing. The resident was found on the floor with a laceration on the forehead and a hematoma on the forearm. The resident was sent to the emergency room, where a displaced femur fracture was diagnosed, requiring surgery. The resident's cognitive status was moderately impaired, as indicated by a Brief Interview for Mental Status (BIMS) score of eight. Interviews and observations revealed that the CNA admitted to transferring the resident without assistance and using the sling already attached to the lift without checking the Kardex for the correct size. Other staff members confirmed that the resident required a large sling and that two staff members should have been present during the transfer. The facility's administrator acknowledged that staff had been educated on proper lift pad identification and the need to check the Kardex before using the lift, but the incident still occurred due to non-compliance with these procedures.
Failure to Address Resident Complaints About Cold Food
Penalty
Summary
The facility failed to ensure that complaints from resident council members regarding cold food were recorded and resolved in a timely manner. Nine out of eleven resident council members had repeatedly complained about the issue, but their grievances were not consistently documented in the meeting minutes. The Social Services Assistant (SSA) admitted to forgetting to record these complaints in the April and May 2024 minutes, although the issue had been discussed in daily stand-up meetings with the interdisciplinary team. The Director of Nursing (DON) was aware of the complaints and had taken steps to ensure nurses were timely in serving meals, believing this was the cause of the cold food. However, the problem persisted despite these efforts. The Assistant Dietary Manager was unaware of the complaints, as she had not received any communication from the resident council or the Dietary Manager, who was absent at the time. The Administrator also believed the issue had been resolved and was not informed of ongoing complaints, as he had not received the resident council meeting minutes for June 2024. The residents involved in the complaints were a mix of cognitively intact and moderately impaired individuals, as indicated by their Brief Interview for Mental Status (BIMS) scores. Despite their cognitive status, their grievances about cold food were not adequately addressed or communicated to the necessary parties, leading to a failure in resolving the issue effectively.
Failure to Serve Food at Appetizing Temperature
Penalty
Summary
The facility failed to ensure that food was served at an appetizing temperature, affecting one of the 15 sampled residents and potentially impacting 74 residents receiving food from the kitchen. The deficiency was identified through observations, interviews, and record reviews. The facility's policy on food preparation guidelines emphasized serving food at a safe and appetizing temperature, but this was not adhered to. During an observation, two lunch meal trays were found to be cold to taste and touch. A resident expressed dissatisfaction with consistently receiving cold breakfast, and the issue had been ongoing for some time. The resident had to request reheating of her meals, indicating a failure in the facility's food service process. Further investigation revealed that the dietary staff faced challenges in maintaining food temperatures due to procedural delays. The cook was unable to prepare meal trays for residents in the hall until all dining room residents were served, causing delays. Additionally, the use of an open metal tray cart, instead of insulated ones, contributed to the food cooling down before reaching the residents. Temperature checks confirmed that the food was not at an appetizing temperature, with significant drops from the initial cooking temperatures. The administrator acknowledged the complaints but was unaware that the resident council continued to express dissatisfaction. The resident involved had a history of Bipolar Disorder and Anxiety Disorder and was cognitively intact, as indicated by her BIMS score.
Inaccurate MDS Assessments for Discharged Residents
Penalty
Summary
The facility failed to accurately complete the Minimum Data Set (MDS) assessments for two residents who were discharged. Resident #77 was admitted with diagnoses including Hemiplegia and Hemiparesis. The Discharge MDS indicated that Resident #77 was discharged to a long-term care facility, but a progress note revealed that the resident was actually transferred to an acute care hospital. Similarly, Resident #79, admitted with Type 2 Diabetes Mellitus, had a Discharge MDS indicating discharge to a short-term general hospital, while the discharge summary and progress notes confirmed the resident was discharged to a long-term care facility. Interviews with the Licensed Practical Nurse (LPN) responsible for the MDS assessments and the Director of Nursing (DON) confirmed the inaccuracies in the MDS assessments for both residents. The LPN acknowledged the errors but was unsure how they occurred. The DON was made aware of the inaccuracies and stated that the facility was working on making corrections for the affected residents.
Failure to Provide Vision Services to Resident
Penalty
Summary
The facility failed to provide necessary vision services to a resident who was visually impaired. The resident, who was admitted with a diagnosis of hypothyroidism, had a prescription for corrective lenses following an eye exam. However, the prescription was not filled because the resident could not afford the glasses, and the facility did not take steps to assist the resident in obtaining them. The Social Services Director (SSD) was aware of the resident's inability to pay and provided over-the-counter reading glasses, which were inadequate for the resident's needs. The SSD did not seek assistance from community support agencies or inform the Administrator about the resident's financial situation. The Director of Nursing (DON) confirmed that the prescription was not filled due to the resident's lack of funds and acknowledged that the facility did not explore other means to assist the resident. The Administrator was unaware of the resident's financial constraints and stated that the facility had previously purchased glasses and dentures for residents in need. The facility's policy required the provision of medically-related social services to help residents attain their highest practicable well-being, which was not adhered to in this case. The resident, who was cognitively intact, expressed difficulty in reading due to the inadequate glasses provided by the facility.
Dishwasher Sanitization Deficiency
Penalty
Summary
The facility failed to ensure the chemical sanitizer for a low-temperature dishwasher had a concentration of at least 50 parts per million (ppm) during one of two dishwasher observations. During an observation, a dietary staff member noticed that dishes were not being cleaned properly, with some having large amounts of dried food and others having small specks of food residue. The staff member set aside these dishes and did not use them for meal preparation. The issue was confirmed by another dietary staff member who acknowledged ongoing problems with the dishwasher, which had been rebuilt two months prior. Further investigation revealed that the dishwasher's chlorine concentration was only 10 ppm, significantly below the required 50 ppm. The Corporate Dietary Consultant identified that the sanitation tubing had not been primed after a new container of sanitation was installed, leading to the inadequate chlorine concentration. This oversight resulted in dishes not being properly sanitized, as confirmed by the dietary staff and the facility's policy requirements.
Failure to Document Vaccine Refusal
Penalty
Summary
The facility failed to provide evidence that two residents refused the influenza and pneumococcal vaccines, as required by their policy. The policy mandates that all residents be offered vaccines and that any refusal be documented in the resident's medical record. However, for two residents, there was no documentation indicating whether they had received or refused these vaccinations. This lack of documentation was confirmed during interviews with the Director of Nursing (DON), the Administrator, and the Resident Care Coordinator (RCC). Resident #22 was admitted with diagnoses including Hemiplegia and Hemiparesis, while Resident #37 had Chronic Atrial Fibrillation. Despite the DON stating that both residents had refused the vaccines, there were no signed declination or refusal forms in their medical records. The RCC, who was responsible for maintaining these records, confirmed the absence of documentation and acknowledged her responsibility in ensuring the records were complete. The Administrator also acknowledged the deficiency, noting that the RCC was expected to maintain the necessary documentation.
Failure to Document COVID-19 Vaccine Refusal
Penalty
Summary
The facility failed to provide evidence that two residents refused the COVID-19 vaccine, as required by their policy on vaccination of residents. The policy mandates that all residents be offered vaccines and that any refusal be documented in the resident's medical record. However, for two residents, there was no documentation indicating whether they had received or refused the COVID-19 vaccination. This lack of documentation was identified during a review of the residents' medical records. Interviews with the Director of Nursing (DON), the Administrator, and the Resident Care Coordinator (RCC) confirmed the absence of signed declination or refusal forms for the two residents. The DON and the Administrator acknowledged the issue, stating that the RCC was responsible for maintaining immunization records. The RCC admitted to being unable to provide the necessary documentation and confirmed her responsibility for ensuring these records were properly maintained.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 12 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Marion
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| North Pointe Health & Rehabilitation | 2 mi | — | 0 | 0 |
| Diversicare Of Meridian | 2 mi | — | 1 | 0 |
| The Oaks Rehabilitation And Healthcare Center | 2.5 mi | — | 1 | 0 |
| Trend Health & Rehab Of Meridian Llc | 2.9 mi | — | 2 | 0 |
| Poplar Springs Nursing Ctr, Llc | 3.2 mi | — | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Bedford Care Center Of Marion.
100% money-back within 48 hours.
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.