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 Mennonite Home during CMS and state inspections, most recent first.
A resident with Alzheimer's and non-ambulatory status fell and sustained injuries during a transfer using a Hoyer lift due to improper attachment of the sling's leg straps. The incident was obscured by a blanket, and staff failed to verify the sling's setup, leading to the resident slipping out and falling.
The facility failed to maintain sanitary conditions during meal service, risking foodborne illness. Staff were observed not following proper glove use and hand hygiene protocols. A CNA and RNCM did not change gloves after touching multiple surfaces, while a cook served food without gloves. A server handled trays with ungloved hands, and a CMA assisted a resident without hand hygiene.
A resident with kidney disease experienced a lack of dignity during meal service when their lunch was delayed by 18 minutes compared to another resident at the same table. Despite inquiries from both residents, staff failed to serve meals in a timely manner, contrary to the administrator's expectation of serving one table at a time.
A facility failed to obtain timely informed consent for the use of lorazepam, an anti-anxiety medication, for a resident with dementia. The resident's MAR indicated that lorazepam was administered on multiple occasions before the consent was completed by the resident's representative. This oversight was confirmed by an LPN, highlighting a deficiency in the facility's process for ensuring informed consent.
A facility failed to complete a comprehensive assessment within the required timeframe for a resident admitted with respiratory failure. Although several MDS assessments were completed, the annual MDS due in September was not done on time, as confirmed by the administrator. This oversight risked unassessed needs for the resident.
A resident admitted with Alzheimer's and Type 2 Diabetes was inaccurately assessed for hand contractures. The Admission MDS did not reflect limitations, despite the care plan noting impaired functional status and interventions for contractures. Observations confirmed contractures, and a family member and LPN acknowledged their presence at admission, but they were not coded on the MDS.
A facility failed to provide appropriate care for a resident with limited ROM, leading to worsening hand contractures. The resident, with Alzheimer's and Type 2 Diabetes, had a care plan to prevent contracture progression, but staff did not follow it. A CNA was unaware of the interventions, and a family member noted that devices were not used regularly, making it harder to manage the contractures. The LPN confirmed the care plan was not followed.
The facility failed to implement and timely investigate fall interventions for two residents, resulting in one resident sustaining a fracture. A resident with Parkinson's and dementia fell due to the absence of a required motion sensor, while another resident with severe cognitive impairment experienced multiple falls with delayed investigations. The LPN admitted to being behind on investigations, and the DNS and Administrator acknowledged the need for timely analysis to prevent neglect or abuse.
Improper Use of Hoyer Lift Leads to Resident Injury
Penalty
Summary
The facility failed to ensure an environment free from accident hazards, resulting in an incident involving a resident who was transferred using a Hoyer lift. The resident, who had been diagnosed with Alzheimer's and restless leg syndrome, was non-ambulatory and considered a fall risk. During a transfer from a recliner to a wheelchair, the resident slid from the sling and fell to the floor, sustaining a left leg femoral fracture and an avulsion injury to the left foot. The incident occurred because the sling's leg straps were not properly attached to the Hoyer lift, as confirmed by video footage and staff interviews. The facility's policy and procedure on mechanical lifts required adherence to the manufacturer's instructions, which included ensuring the sling was properly connected to the hooks of the swivel bar before moving the patient. However, during the transfer, a blanket covered the resident's legs, obscuring the view of the sling's placement. Staff involved in the transfer did not verify the placement of the straps before lifting the resident. The video footage revealed that the straps were not crisscrossed through the resident's legs, allowing the resident to slip out of the sling. Interviews with staff members involved in the incident indicated a lack of verification of the sling's proper setup. One CNA stated she was not sure about the placement of the sling due to the blanket covering the resident's legs, while another CNA did not double-check the straps before proceeding with the transfer. The facility's administration acknowledged that the improper setup of the sling contributed to the resident's fall and subsequent injuries.
Failure to Maintain Sanitary Conditions During Meal Service
Penalty
Summary
The facility failed to maintain sanitary conditions during meal service in two dining rooms, which placed residents at risk for foodborne illness. On multiple occasions, staff members were observed not adhering to proper glove use and hand hygiene protocols. For instance, a CNA on the third floor dining room was seen touching various surfaces such as cupboards, clean cups, plates, and serving utensils without changing gloves. Similarly, a cook on the second floor dining room served food without wearing gloves, directly touching plates and utensils. An RNCM also failed to change gloves after touching multiple surfaces during meal service. Additionally, a server was observed handling meal trays with ungloved hands before sanitizing them, and an infection preventionist confirmed that staff should change gloves and sanitize hands after touching equipment. Another incident involved a CMA who moved a chair and assisted a resident with their meal without performing hand hygiene. The CMA acknowledged the failure to perform hand hygiene after moving the chair and before assisting the resident with their meal.
Failure to Ensure Dignity in Meal Service
Penalty
Summary
The facility failed to ensure residents were treated with dignity during meal service, specifically affecting Resident 29. Resident 29, who was admitted to the facility with a diagnosis of kidney disease, was observed during a lunch meal seated at a dining table with another resident. Staff delivered lunch to the other resident but not to Resident 29, proceeding to serve other residents in the dining room instead. The other resident at the table repeatedly asked staff about the whereabouts of Resident 29's meal, and staff acknowledged the delay, stating that the meal was being prepared. Resident 29 also inquired about their meal and received the same response. The other resident chose to stop eating and wait for Resident 29 to be served. Ultimately, Resident 29 received their meal 18 minutes after the other resident at the table had been served. The facility's administrator stated that the expectation was for staff to serve meals one table at a time, ensuring each resident at the table received their meal before moving on to another table. This expectation was not met, resulting in a delay and lack of dignity for Resident 29 during the dining experience.
Failure to Obtain Timely Informed Consent for Psychotropic Medication
Penalty
Summary
The facility failed to timely inform the resident representative of the risks and benefits of psychotropic medication use for a resident with dementia, leading to a lack of informed consent. The resident was admitted to the facility with a diagnosis of dementia, and their cognition was severely impaired. The resident's medication administration record (MAR) showed an order for lorazepam, an anti-anxiety medication, as needed, which was administered on three occasions before a consent for treatment was completed. The consent was only obtained after the medication had been administered, as confirmed by an interview with the LPN Resident Care Manager.
Failure to Complete Timely Comprehensive Assessment
Penalty
Summary
The facility failed to complete a comprehensive assessment within the required timeframe for a resident who was admitted in June 2018 with a diagnosis of respiratory failure. The Minimum Data Set (MDS) assessments for this resident were completed on several occasions, including an annual MDS in September 2023 and quarterly MDS assessments in December 2023, March 2024, and June 2024. However, the annual MDS due in September 2024 was not completed within the required timeframe, as confirmed by the facility administrator on November 18, 2024. This oversight placed residents at risk for unassessed needs.
Failure to Accurately Assess Resident's Hand Contractures
Penalty
Summary
The facility failed to ensure accurate assessments for a resident with limited range of motion, specifically regarding hand contractures. The resident, admitted in October 2024 with Alzheimer's disease and Type 2 Diabetes, was noted in the Admission MDS to have no limitations in upper extremities. However, the active care plan indicated impaired functional status in various activities and included interventions for bilateral hand contractures. Observations on November 18, 2024, confirmed the presence of hand contractures, and no splinting was observed. A family member confirmed the contractures were present upon admission, and the LPN Resident Care Manager acknowledged that the contractures were not coded on the MDS.
Failure to Prevent Decline in Resident's Range of Motion
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent further decline in range of motion for a resident with limited ROM. The resident, admitted in October 2024 with Alzheimer's disease and Type 2 Diabetes, had impaired functional status in various activities and was at risk for worsening hand contractures. The care plan included interventions to prevent progression of bilateral hand contractures by inserting a rolled ace wrap or washcloth into the resident's hands daily. However, on November 18, 2024, the resident was observed with contractures in both hands, and no interventions were noted. A CNA was unaware of any specific care related to the contractures, and a family member reported that intervention devices were not being used regularly, leading to increased difficulty in managing the contractures. The LPN resident care manager confirmed that the contractures were present upon admission and that the care plan interventions were not followed by the staff.
Failure to Implement and Timely Investigate Fall Interventions
Penalty
Summary
The facility failed to ensure effective fall interventions for two residents, leading to significant incidents. Resident 1, diagnosed with Parkinson's disease and dementia, was assessed to be at risk for falls and required a motion sensor when seated in a recliner. However, on the day of the incident, the motion sensor was not placed by the CNA after transferring the resident to the recliner. As a result, Resident 1 attempted to walk unassisted, fell, and sustained a right arm fracture. The investigation revealed that the motion sensor was not in place at the time of the fall, and the fall was only reported after a former resident notified the staff. Resident 3, with severe cognitive impairment and poor safety awareness, experienced multiple falls within a short period. The investigations into these falls were significantly delayed, with some taking over a month to complete. The LPN Resident Care Manager admitted to being behind on completing these investigations. The DNS and Administrator acknowledged that timely investigations are crucial to ensure care plans are followed and to analyze falls to prevent neglect or abuse.
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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 Albany
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Regency Albany | 2.6 mi | — | 14 | 0 |
| Timberline Post Acute | 3.4 mi | — | 8 | 0 |
| Corvallis Manor | 8.4 mi | — | 6 | 0 |
| Avamere Rehabilitation Of Lebanon | 8.6 mi | — | 16 | 0 |
| Lebanon Veterans Home | 8.8 mi | — | 15 | 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.