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 The Enclave At Barnesville during CMS and state inspections, most recent first.
The facility did not submit required staffing data for the fourth quarter of 2024 to the PBJ, affecting all residents with a census of 46. The review showed a one-star staffing rating, low weekend staffing, no RN hours, and lack of 24-hour licensed nursing coverage. The Administrator indicated that corporate handles submissions but had not provided proof of submission despite multiple requests.
A resident was observed taking ice from the ice chest near the nurses' station without practicing hand hygiene, and the ice scoop was left inside the chest. Two aides were present, and a CNA confirmed that residents should not help themselves to ice.
The facility failed to accurately complete PASARR for three residents, leading to deficiencies in identifying mental health conditions. A resident's PASARR inaccurately indicated no mental illness despite diagnoses of major depressive disorder and PTSD. Another resident's PASARR failed to reflect bipolar disorder and medication use. A third resident's PASARR misclassified alcohol dependence and omitted anxiety disorder. The facility's policy requires screening for mental illness or developmental disabilities, but these procedures were not followed.
The facility failed to update and individualize care plans for two residents, one requiring continuous oxygen therapy and another receiving Zyprexa, an antipsychotic medication. The care plans did not reflect these treatment orders, as confirmed by facility staff during interviews.
The facility failed to monitor a resident's blood glucose before insulin administration and did not timely identify another resident's edema. One resident with diabetes did not have their blood glucose checked as ordered, and insulin was administered without this check. Another resident reported foot swelling for weeks, but it was not documented or assessed until a survey. The DON confirmed these oversights.
A facility failed to provide a prescribed low air-loss mattress for a resident at risk for pressure ulcers. Despite the care plan indicating the need for a pressure-reducing mattress, observations confirmed the absence of the mattress, which was verified by an LPN. The resident had multiple diagnoses, including dementia and chronic kidney disease, and was at risk for skin integrity issues.
A facility failed to follow an order for non-skid strips for a resident at risk for falls. The resident, with conditions such as dementia and osteoarthritis, had a care plan requiring non-skid strips by the bed. Observations showed the strips were missing, confirmed by an LPN.
A resident experienced a significant weight loss of 5.45% in one month, but the facility failed to implement necessary nutritional interventions. Despite a care plan that included monitoring diet and notifying a physician of significant weight loss, no additional orders were made. The resident's meal intake was low, with 70% of meals consumed at 0-50% and 11 meals refused. Staff interviews revealed fluctuating eating habits, but no supplements or medications were provided to assist in maintaining weight.
A facility failed to replace a resident's oxygen humidifier bottle weekly as required, affecting a resident with chronic respiratory conditions. The humidifier bottle was observed to be over a month old, contrary to the facility's policy that mandates weekly replacement. Interviews with an LPN and the DON confirmed the oversight.
A facility failed to provide a comprehensive assessment and individualized care plan for a resident with PTSD. The resident's admission assessment did not document PTSD or identify trauma history and triggers. Staff interviews revealed a lack of awareness about the resident's PTSD causes and triggers, and the facility's policy on Trauma Informed Care was not followed.
A resident with recurrent UTIs was prescribed Cipro prophylactically despite cultures showing resistance to it. The resident, with a history of chronic conditions, was given Cipro by a urologist in January, although no new UTI was present. An LPN expressed uncertainty about the choice of Cipro, noting the resident's allergy to Macrobid. There was no documentation supporting the prophylactic use of Cipro, and the resident's representative was unaware of the resistance issue.
The facility failed to ensure appropriate diagnoses for psychotropic medication and did not support declining GDR recommendations for two residents. One resident received increased doses of Abilify without documented behaviors, while another received Zyprexa without a supporting diagnosis. The facility did not adhere to its policy on tapering medication and GDRs.
The facility failed to meet financial obligations, resulting in delayed payroll for 39 staff members and an outstanding balance with a therapy provider, risking interruption of services for residents. The facility lacked an effective system to monitor financial solvency, leading to potential care disruptions.
The facility's governing body failed to manage financial obligations, leading to payroll issues and vendor payment delays. Multiple surveys revealed insufficient funds for employee paychecks and outstanding balances with vendors, resulting in service threats. The facility was placed under receivership due to financial mismanagement.
The facility failed to ensure financial obligations were met, leading to payroll issues and outstanding vendor balances. Interviews revealed a lack of effective financial monitoring and an ineffective QAPI program. Despite attempts to address payroll delays, the facility continued to struggle with financial solvency.
Failure to Submit Staffing Data to PBJ
Penalty
Summary
The facility failed to submit the required staffing information for the fourth quarter of 2024 to the Payroll Based Journal (PBJ) data, which had the potential to affect all residents, with a census of 46. A review of the PBJ staffing report for the period from July 1st, 2024, through September 30th, 2024, revealed that the facility did not submit the necessary data. This resulted in a one-star staffing rating, excessively low weekend staffing, no registered nurse (RN) hours, and a lack of licensed nursing coverage 24 hours per day. During an interview, the Administrator stated that the corporate office is responsible for submitting the staffing data. Despite reaching out to corporate multiple times for proof of submission, the Administrator had not received any evidence. A subsequent interview confirmed that corporate was unable to provide evidence that the facility had submitted the required staffing information for the specified quarter.
Infection Control Breach at Nurses' Station
Penalty
Summary
The facility failed to maintain proper infection control practices, which had the potential to affect 26 out of 46 residents. During an observation, a male resident was seen helping himself to ice from the ice chest located next to the nurses' station without practicing hand hygiene. The ice scoop was left inside the ice chest, which is against standard infection control practices. Two aides were present at the nurses' station during this observation. In an interview, a Certified Nursing Assistant (CNA) confirmed the observation and stated that residents typically do not and should not help themselves to ice, but should ask for assistance.
Inaccurate PASARR Completion for Residents
Penalty
Summary
The facility failed to ensure accurate completion of Preadmission Screening and Resident Review (PASARR) for three residents, leading to deficiencies in identifying mental health conditions. Resident #40 was admitted with diagnoses including Alzheimer's disease, major depressive disorder, PTSD, and dementia with behavioral disturbances. Despite these conditions, the PASARR dated 02/23/24 inaccurately indicated no mental illness, which was confirmed by the Director of Nursing (DON) during an interview. Similarly, Resident #43's PASARR failed to reflect their mental health diagnoses, including bipolar disorder, and the use of medications such as Zoloft and Depakote, as confirmed by the DON. Resident #3's PASARR was also inaccurate, as it did not list anxiety disorder and misclassified alcohol dependence as a psychotic disorder. The Social Service Director (SSD) acknowledged the inaccuracies and the lack of a PASARR review upon the resident's admission. The facility's policy requires screening for serious mental illness or developmental disabilities prior to admission and within 14 days of a new diagnosis or significant change in status, but these procedures were not followed, leading to the deficiencies noted in the report.
Failure to Update Care Plans for Oxygen Therapy and Antipsychotic Medication
Penalty
Summary
The facility failed to revise and individualize the care plans for two residents, leading to deficiencies in their treatment management. Resident #7, who was admitted with multiple diagnoses including diabetes mellitus, chronic obstructive pulmonary disease, and acute respiratory distress syndrome, had a physician's order for continuous oxygen therapy at four liters per minute via nasal cannula. However, the resident's care plan was not updated to reflect this treatment order. This oversight was confirmed by a Registered Nurse during an interview, who acknowledged that the care plan did not indicate the resident was receiving oxygen therapy. Similarly, Resident #46, admitted with diagnoses such as gastrostomy, anemia, and malignant neoplasm of the colon, was receiving Zyprexa, an antipsychotic medication, as per the Medication Administration Record. Despite this, the resident's care plan was not individualized to include the treatment order for Zyprexa. The Director of Nursing confirmed during an interview that the care plan did not reflect the administration of the antipsychotic medication. These failures to update and individualize care plans for the residents' specific treatments were identified as deficiencies during the survey.
Failure to Monitor Blood Glucose and Identify Edema
Penalty
Summary
The facility failed to ensure that a resident's blood glucose level was obtained prior to administering insulin, as per physician orders. Resident #33, who has a history of Alzheimer's disease, dementia, and diabetes mellitus, did not have their blood glucose level checked on two consecutive days, and insulin was administered without this critical check on one of those days. The resident had previously refused care, becoming aggressive, which was documented in the nursing progress notes. The Director of Nursing confirmed the oversight in obtaining the blood glucose levels as per the physician's orders. Additionally, the facility did not timely identify and document edema in another resident. Resident #26, who has hemiplegia and diabetes, reported right foot pain and swelling, which had been present for three to four weeks. Despite the resident and a CNA acknowledging the edema, it was not documented or assessed by nursing staff until it was brought to the attention of an LPN during the survey. The Director of Nursing confirmed the lack of documentation regarding the resident's condition, and the facility's policy requires prompt notification of changes in a resident's condition.
Failure to Provide Ordered Pressure-Reducing Mattress
Penalty
Summary
The facility failed to follow an order for an alternating air mattress for a resident at risk for developing pressure ulcers. Resident #32, who was admitted with diagnoses including stage three chronic kidney disease, hyperlipidemia, anxiety disorder, dementia, and osteoarthritis, was identified as having the potential for skin integrity impairment. The care plan included interventions such as a pressure-reducing mattress. However, observations on multiple occasions revealed that the resident did not have the prescribed low air-loss mattress with side bolsters. This was confirmed by an LPN during an interview, indicating non-compliance with the care plan designed to prevent pressure ulcers.
Failure to Implement Fall Prevention Measures
Penalty
Summary
The facility failed to ensure that an order for non-skid strips was followed for a resident at risk for falls. Resident #32, who was admitted with diagnoses including stage three chronic kidney disease, hyperlipidemia, anxiety disorder, dementia, and osteoarthritis, was identified as being at risk for falls due to confusion, gait/balance issues, and other factors. The resident's fall care plan included interventions such as ensuring non-skid footwear and placing non-skid strips to the right of the bed. However, observations on multiple occasions revealed that there were no non-skid strips in front of the resident's bed, as required by an order dated 03/22/23. This was confirmed by an interview with an LPN, who acknowledged the absence of the non-skid strips.
Failure to Implement Interventions for Significant Weight Loss
Penalty
Summary
The facility failed to implement necessary interventions for a resident who experienced a significant weight loss of 5.45% within one month. The resident, who was admitted with diagnoses including dementia, urinary tract infection, and type II diabetes, was on a consistent carbohydrate diet. Despite the care plan indicating the need to monitor diet tolerance, meal/fluid intakes, and notify the physician of significant weight loss, no additional nutritional interventions were ordered following the weight loss. The resident's meal intake records showed that 70% of meals were consumed at 0-50%, with 11 meals completely refused, indicating inadequate nutritional intake. Interviews with facility staff revealed that the resident's eating habits fluctuated, and although alternatives were offered, the resident was not receiving any medications or supplements to assist in maintaining weight. The Registered Dietician acknowledged the weight loss but did not implement any interventions, as the resident's weight was considered to be at baseline from a previous stay. This lack of action contributed to the deficiency in providing adequate nutrition to maintain the resident's health.
Failure to Timely Replace Oxygen Humidifier Bottle
Penalty
Summary
The facility failed to ensure timely replacement of a resident's oxygen humidifier bottle, affecting a resident who was receiving oxygen therapy. The resident, who had a history of chronic obstructive pulmonary disease, asthma, dementia, diabetes mellitus, congestive heart failure, and atrial fibrillation, was admitted with an order for continuous oxygen administration at four liters per minute via nasal cannula due to low oxygen saturation. During an observation, it was noted that the resident's oxygen humidifier bottle was dated over a month prior, indicating it had not been changed weekly as required by the facility's policy. Interviews with the LPN and the DON confirmed that the humidifier bottle should have been replaced weekly, as per the facility's policy on infection control and oxygen therapy. The policy specified that humidifier bottles are to be replaced weekly on the Sunday night shift. The failure to adhere to this policy resulted in the deficiency noted during the survey, as the humidifier bottle had not been changed in accordance with the established schedule.
Failure to Provide Individualized PTSD Care Plan
Penalty
Summary
The facility failed to ensure a comprehensive assessment and individualized plan of care for a resident with Post Traumatic Stress Disorder (PTSD). The resident, who was admitted with diagnoses including Alzheimer's disease, major depressive disorder, PTSD, and dementia with behavioral disturbances, did not have PTSD documented in the admission assessment. The assessment also failed to identify any history of trauma or triggers, and the 48-hour care plan included generic interventions without individualization. The comprehensive plan of care lacked evidence of an individualized approach to managing the resident's PTSD. Interviews with facility staff revealed a lack of awareness regarding the cause of the resident's PTSD and the absence of a comprehensive assessment or care plan. The Director of Nursing was unaware of the PTSD triggers, and an LPN had to reach out to the resident's family to gather information. The family indicated that the resident might have been physically or sexually abused as a child, with men being a trigger for her agitation and aggression. The facility's policy on Trauma Informed Care was not followed, as it required social services to interview new residents for trauma history and initiate a comprehensive care plan with individualized goals and interventions.
Unnecessary Antibiotic Use in Resident with UTI
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary antibiotics, specifically affecting a resident with a history of recurrent urinary tract infections (UTIs). The resident, who was admitted with diagnoses including atherosclerotic heart disease, chronic kidney disease, urinary incontinence, and mild cognitive impairment, had multiple urine cultures showing resistance to the antibiotic Cipro. Despite this resistance, the resident was prescribed Cipro prophylactically by a urologist in January 2025, even though there was no new UTI at that time to justify starting another antibiotic. Interviews with a Licensed Practical Nurse (LPN) revealed uncertainty about why Cipro was chosen for prophylaxis when the resident's cultures consistently showed resistance to it. The LPN also noted that the resident was allergic to Macrobid, the urologist's usual choice for prophylaxis, leading to the decision to use Cipro. However, there was no documentation from the urology department to support this prophylactic treatment, and the resident's representative was unaware of the resistance issue. The facility's policy on antibiotic stewardship emphasized the importance of appropriate antibiotic use and communication of lab results to prescribers, which was not adhered to in this case.
Inappropriate Psychotropic Medication Management
Penalty
Summary
The facility failed to ensure appropriate diagnoses for psychotropic medication and did not have supporting evidence for declining gradual dose reduction (GDR) recommendations and increasing doses of psychotropic medication for two residents. Resident #43 was admitted with diagnoses including dementia with psychotic disturbance, anxiety, major depressive disorder, and unspecified psychosis. Despite pharmacy recommendations for GDRs on medications such as Abilify, Zoloft, and Depakote, the physician disagreed, citing persistent target symptoms, although there was no documented evidence of behaviors. The Director of Nursing (DON) confirmed the lack of documentation and justification for increasing Abilify and the absence of attempts for GDRs in the past eight months. Resident #46 was admitted with diagnoses including gastrostomy, anemia, malignant neoplasm of the colon, acute post-thoracotomy pain, depression, and anxiety. The resident's Minimum Data Set (MDS) assessment indicated intact cognition with no hallucinations, delusions, or behavioral issues. However, the resident was receiving Zyprexa, an antipsychotic, without a supporting diagnosis. The pharmacist informed the physician of this discrepancy, and the DON verified the inappropriate prescription. The facility's policy on tapering medication and GDRs requires attempts to reduce antipsychotic drugs unless clinically contraindicated. Despite this policy, the facility did not adhere to the guidelines, as evidenced by the lack of documented behaviors and the absence of attempts to reduce medication dosages. The deficiencies highlight the facility's failure to follow its own policies and ensure appropriate medication management for residents.
Financial Mismanagement Leads to Care Deficiency
Penalty
Summary
The facility failed to meet its financial obligations, which led to a deficiency in the delivery of care and maintenance. This deficiency was identified when it was discovered that the facility did not have sufficient funds to make payroll on the scheduled date, resulting in 39 staff members not receiving their paychecks on time. This included various staff members such as the Administrator, Director of Nursing, Registered Nurses, Licensed Practical Nurses, and other essential personnel. The delay in payroll was due to insufficient funds in the facility's bank account, which was confirmed by the Bank of Oklahoma Treasury Client Services Representative. Additionally, the facility neglected to pay its therapy provider, Broad River Rehabilitation, leading to a significant outstanding balance for services rendered from December 2023 through May 2024. The therapy provider had notified the facility that services would be terminated if a substantial payment was not received, which placed residents receiving therapy services at risk of having their care interrupted. The facility's financial instability also affected its ability to pay other vendors, such as Medline Medical Supplies, which had an outstanding balance and a past due amount. The investigation revealed that the facility did not have a comprehensive and effective system in place to monitor its financial solvency and ensure that all bills were paid timely. This lack of financial oversight and management led to the potential interruption of essential services and care for all residents, as the facility was unable to meet its financial obligations to staff and service providers.
Removal Plan
- The facility implemented corrective actions to remove Immediate Jeopardy.
- The Administrator identified payroll issues and verified payroll was met.
- All staff received education on the facility abuse/neglect policy.
- All residents and/or resident representatives were interviewed by the interdisciplinary team to ensure care needs were being met.
- Daily audits were implemented to ensure medical supplies, food, medications, and staff continue to be provided.
- R&R Management was appointed as the new management company to fund payroll.
- Payroll ACHs would be deposited, with audits completed to ensure all funds were received.
- Letters to notify vendors of the new receiver were sent.
- A Broad River payment plan was initiated to pay 25% of outstanding balances each month.
- Staffing contracts were verified, and incentives were offered for immediate/same-day shift pickups.
- Managers were educated on shift pickup via in-service.
- A plan for ancillary staffing was implemented, including sharing staff between facilities managed by the company.
- Weekly audits of financial obligations were implemented to ensure delivery of care continues as required.
- Results of audits and interventions would be brought to the QAPI meeting monthly and as needed.
Failure in Financial Management and Governance
Penalty
Summary
The facility failed to establish an effective governing body responsible for implementing policies regarding management and operation, including financial obligations. This deficiency was identified through multiple complaint surveys, revealing ongoing issues with financial solvency, particularly concerning employee payroll. On several occasions, employees did not receive their paychecks due to insufficient funds, and the facility was unable to provide adequate explanations for these financial shortcomings. Additionally, the facility had outstanding balances with vendors and suppliers, leading to shut-off notices and threats of service termination. Interviews with facility staff, including the Administrator and Director of Nursing, highlighted the lack of a comprehensive system to monitor financial solvency. The Administrator was unable to clarify the facility's financial processes, and it was unclear whether Epic Healthcare Solutions was responsible for payments. The facility's owner attempted to address payroll issues by offering bonuses to affected staff, but the underlying financial management problems persisted. The facility was placed under court-ordered receivership, indicating severe financial mismanagement. Vendor interviews further exposed the facility's financial instability. The therapy provider reported an outstanding balance of over $84,000, threatening to cease services without a substantial payment. Similarly, a medical supplies vendor noted a past due balance, though the facility failed to provide explanations or evidence of good standing. The facility's governing body policy outlined fiduciary duties and responsibilities, but the lack of active engagement and effective financial oversight contributed to the ongoing deficiencies.
Financial Solvency and QAPI Program Deficiency
Penalty
Summary
The facility failed to ensure continuous evaluations were in place to verify financial obligations were met as planned, which could potentially disrupt resident care and services. This deficiency was identified through multiple complaint surveys, revealing ongoing issues with financial solvency, particularly concerning employee payroll and vendor payments. On several occasions, employees did not receive their paychecks due to insufficient funds, and the facility had outstanding balances with various vendors, leading to shut-off notices and threats of service termination. During interviews, the facility's Administrator and Owner were unable to provide satisfactory explanations for the financial issues. The Administrator was unsure of the payment processes and whether Epic Healthcare Solutions was responsible for all payments. The Owner admitted to issues with payroll processing due to bank policies and attempted to compensate employees with bonuses for delayed payments. Despite these efforts, the facility continued to struggle with meeting its financial obligations, as evidenced by the ongoing issues with payroll and vendor payments. The facility's Quality Assurance and Performance Improvement (QAPI) program was found to be ineffective in addressing these financial deficiencies. The program was supposed to track and measure performance, identify and prioritize quality deficiencies, and implement corrective actions. However, the lack of a comprehensive system to monitor financial solvency and ensure timely payments to employees and vendors indicated a failure in the QAPI program's implementation. This deficiency was investigated under Complaint Number OH00154712.
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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 Barnesville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Emerald Pointe Health And Rehab Ctr | 2.1 mi | — | 1 | 0 |
| Cumberland Pointe Care Center | 13.2 mi | — | 15 | 0 |
| Stellar Care Center | 14.7 mi | — | 43 | 1 |
| Continuing Healthcare At Forest Hill | 15.5 mi | — | 9 | 0 |
| Park Health Center | 15.7 mi | — | 5 | 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.