Above average — CMS composite of the measures below.
A standard survey is most likely before around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at The Springs Of Hillcrest during CMS and state inspections, most recent first.
Incomplete transfer notifications were provided for two residents who were sent to the hospital. One resident had bloodstream infection, paraplegia, and bone infection, and the other had a shoulder fracture, pancreatic cancer, bone cancer, and muscle weakness. In both cases, staff provided only a bed-hold notice instead of a complete transfer notice, and the documents did not include the reason for transfer, effective date, transfer location, appeal rights, or OLTC and Ombudsman contact information.
Expired wound care supplies were found in both Station #1 and Station #2 medication rooms, including oil emulsion dressings, Silvasorb gel, DermaSyn/AG, calcium alginate dressing, Povidone Iodine, and hydrogel saturated gauze. An LPN acknowledged the items were expired but said they could still be used because they were available, while also stating expired products should not be used because they can reduce medication effectiveness. The DON and Administrator confirmed the items were outdated, and facility policy required outdated drugs or biologicals to be returned to the dispensing pharmacy or destroyed.
The facility failed to ensure proper food safety and sanitation practices, including improper storage of food domes, used coffee filters left on counters, uncovered serving items, buildup of substances on air vents and walls, damaged kitchen equipment, improperly sealed and undated food items, and dirty storage areas. The facility's policies for cleanliness and food storage were not followed.
The facility failed to ensure the dignity and privacy of two residents by not using privacy bags for their indwelling catheter bags. Both the CNA and IP confirmed that the catheter bags should have been in privacy bags to protect the residents' dignity. The DON acknowledged the requirement, but the facility's policy on catheter care did not address the use of privacy bags.
The facility failed to keep rear casters/wheels unlocked during patient lifts, did not remove damaged lift pads from service, and left harmful chemicals accessible to residents. Staff were unaware of proper lift procedures, and damaged equipment was not appropriately handled, posing risks to resident safety.
The facility failed to ensure staff competency in caring for a resident on Enhanced Barrier Precautions (EBP) and using hygiene supplies correctly. Staff provided care without required gowns and did not follow soap application instructions, risking skin irritation for the resident.
The facility failed to ensure proper administration and storage of medications. Two residents were observed self-administering nebulizer treatments without being assessed for their ability to do so safely. Additionally, a medication cart was left unlocked, and a narcotic box containing controlled substances was found with only one lock, contrary to the facility's policy.
The facility failed to ensure proper storage and handling of respiratory mask tubing and nasal cannula tubing, proper bagging of dirty laundry, and appropriate use of PPE and hand hygiene during perineal care and other high-contact activities. Additionally, a resident's denture brush was not stored in a sanitary manner.
The facility failed to protect the privacy and dignity of a resident with diabetes and a deep tissue injury during wound care. The resident was observed receiving treatment without the curtain being pulled or the door being closed, despite being cognitively intact. The Treatment Nurse and DON confirmed the lapse in privacy, which is against the facility's dignity policy.
The facility failed to ensure a resident's care plan included oxygen therapy and CPAP as ordered by a physician. Despite the resident's dependence on supplemental oxygen and observations confirming the oxygen concentrator settings, the care plan lacked the necessary documentation. Policies for CPAP/BiPAP support and oxygen administration were not reflected in the care plan, leading to the deficiency.
The facility failed to ensure a leg strap was in place to prevent trauma from an indwelling catheter for a resident with severe cognitive impairment and multiple medical diagnoses. Observations and interviews revealed that the catheter tubing was not secured, causing discomfort to the resident during repositioning. Both the Infection Preventionist and the Director of Nursing confirmed that a leg strap should be in place, but the deficiency persisted.
Incomplete Transfer Notifications
Penalty
Summary
The facility failed to ensure written notification of transfer or discharge to the hospital was provided to the resident and/or the resident’s representative with all required information for two residents reviewed for hospitalization. For Resident #86, the record showed a BIMS score of 15, indicating the resident was cognitively intact, and diagnoses that included bloodstream infection, paraplegia, and bone infection. A progress note documented that the DON spoke with hospital infectious disease staff and was told that due to the nature of the diagnosis, [medication name] was the only treatment and the resident would need to transfer back to the hospital for treatment. During record review, no notice of bed hold or transfer was found in Resident #86’s clinical record. When the Administrator was asked for the transfer notice, a form titled Notification of Bed Hold Policy was provided instead, but it did not include the reason for transfer, the effective date of transfer, the location of transfer, a statement of appeal rights with required information, or the name, address, and telephone number of the Office of Long-Term Care and the Ombudsman. Social Services later stated that a letter notification of transfer and bed hold was sent to the family in the mail, but no additional written information was provided to include the missing transfer details, appeal process, or contact information. For Resident #81, the discharge MDS indicated the resident was cognitively intact and had diagnoses including a right shoulder fracture, pancreatic cancer, bone cancer, and muscle shrinking and weakening. The electronic transfer form showed the resident transferred to the hospital, but when the Administrator was asked for the written documentation given at the time of transfer, the only document provided was a Notification of Bed Hold. That document also lacked the required transfer information, including the reason for transfer, effective date, location, appeal rights, and contact information for the OLTC and Ombudsman. Facility staff and the Administrator confirmed that no additional written information was provided to the resident or representative.
Expired wound care supplies found in both medication rooms
Penalty
Summary
The facility failed to ensure wound care supplies available for use were not expired in 2 of 2 medication rooms observed, including Station #1 and Station #2. During a concurrent observation and interview in Station #2 medication room, an LPN identified expired wound care products, including oil emulsion dressings with expiration dates of 09/2021 and 02/2023, a Silvasorb gel tube with an expiration date of 04/2025, and a DermaSyn/AG tube with an expiration date of 03/29/2025. The LPN stated the products were expired and also indicated they could be used because they were available. During a concurrent observation and interview in Station #1 medication room, additional expired wound care products were found, including calcium alginate dressing with an expiration date of 04-21-2024, oil emulsion dressings with expiration dates of 02/2023 and 09/2023, Povidone Iodine bottle with an expiration date of 02/2025, DermaSyn/AG gel tube with an expiration date of 03-29-25, and hydrogel saturated gauze with expiration dates of 10/27/24 and 02/2023. The LPN again stated the products were expired and could be used because they were available, while also stating expired products should not be used since they can reduce the effectiveness of the medication. The DON and Administrator later confirmed the identified products were outdated and should not be used because expired medications can reduce effectiveness. Facility policy titled Storage of Medications stated outdated drugs or biologicals are to be returned to the dispensing pharmacy or destroyed.
Food Safety and Sanitation Deficiencies
Penalty
Summary
The facility failed to ensure proper food safety and sanitation practices in the kitchen and food storage areas. Observations revealed that food domes were stored improperly with the inside part facing up, and used coffee filters were left on the counter next to unsealed packages of coffee. Additionally, various serving items such as bowls, cups, and plates were not covered, and there were black flies in the kitchen. The air vents above the food prep area had a buildup of yellowish, brown, and black substances, and the wall below the vents had a black grimy buildup with missing or chipping paint. A spatula on the clean drying side of the sink was found to have torn and missing pieces, raising concerns about food particles being trapped in the damaged areas. The facility's freezer and deep freezer contained improperly sealed and undated food items, as well as ice chunks and black specks. The bottom shelf of the freezer was held up with a coffee carafe due to a cracked plastic wall, and the outside bottom of the freezer was missing a vent cover with a buildup of fuzzy substances. The dry goods storage area had a flour bin with a scoop left inside, an expired bottle of liquid smoke, and an outlet covered in a black sticky substance with whitish-gray fuzz. The kitchen refrigerator had a gallon of creamy Caesar salad dressing with drips on the outside, and the inside bottom had a brownish-yellow buildup. Food was served from a steam table placed against a wall with a black grimy buildup and missing paint, and various food items were stored on dirty shelves and carts. The shelving area above the food prep counter contained undated and smeared food containers. The stand-up freezer had a box of sugar cookies without an open date, and a piece of metal on the floor between the kitchen entrance and work area was missing a non-slip strip, posing a tripping hazard. The lower wall area across from the prep counter had a brownish unknown substance and a missing floorboard, with a black buildup in the crease between the floor and wall. The facility's policies for maintaining cleanliness and proper food storage were not followed, as confirmed by the Dietary Manager.
Failure to Ensure Resident Dignity and Privacy
Penalty
Summary
The facility failed to ensure the dignity and privacy of two residents, identified as Resident #187 and Resident #438, by not using privacy bags for their indwelling catheter bags. Resident #438, who had severe cognitive impairment and was admitted with an indwelling catheter, was observed multiple times over several days with the catheter bag hanging from the bedside without a privacy bag. Both a Certified Nursing Assistant (CNA) and the Infection Preventionist (IP) confirmed that the catheter bag should have been in a privacy bag to protect the resident's dignity. The Director of Nursing (DON) also acknowledged that a privacy bag should be used to cover the catheter bag to maintain the resident's dignity. Similarly, Resident #187, who had acute kidney failure, acute cystitis, and a urinary tract infection, was observed with an uncovered indwelling catheter bag draining yellow urine visible from the open doorway. The facility's policy on dignity stated that residents should be treated with dignity and respect at all times. A Registered Nurse (RN) confirmed that the catheter bag should be placed in a privacy bag as it is a dignity issue. The DON reiterated that staff are expected to place catheters in privacy bags to protect the residents' dignity. However, the facility's policy on catheter care did not address the use of privacy bags.
Deficiencies in Patient Lift Procedures and Chemical Storage
Penalty
Summary
The facility failed to ensure the rear casters/wheels were kept in the unlocked position when lifting and lowering residents using a patient lift, which was observed in three residents. Nursing assistants were seen locking the rear casters/wheels during the lifting process, which they believed was for safety. However, this practice is incorrect as the wheels should remain unlocked to allow the lift to move with the resident's sudden movements. The Director of Nursing (DON) confirmed that staff had been in-serviced on mechanical lifts but was unaware that the wheels should remain unlocked during lifting and lowering procedures. The facility also failed to remove damaged or frayed lift pads from service, as observed with one resident who had an order for mechanical lift assistance. A resident was seen sitting on a frayed lift pad, and the CNAs involved were unsure of the process for removing such damaged equipment from circulation. The DON stated that any staff member could remove a damaged lift pad from service, but this procedure was not followed. Additionally, the facility did not ensure that chemicals were safely stored to prevent potential harm to residents. In one instance, two bottles of air freshener with harmful inhalation warnings were observed in a resident's room on multiple occasions. Both an LPN and the DON confirmed that such items should not be out and visible to wandering residents, indicating a lapse in maintaining a safe environment for residents with cognitive impairments.
Failure to Follow Enhanced Barrier Precautions and Proper Hygiene Procedures
Penalty
Summary
The facility failed to ensure that staff displayed competency in caring for residents on Enhanced Barrier Precautions (EBP) and using hygiene supplies according to the manufacturer's directions. Specifically, Resident #41, who had diagnoses including a stage 4 pressure ulcer, urinary tract infection, and paraplegia, was observed receiving care from staff who did not follow EBP protocols. The resident had physician's orders for EBP related to sacrum and heel wounds and a suprapubic catheter. Despite these orders, staff members were observed providing care while wearing only gloves, without the required gowns. Additionally, the soap used for the resident's bed bath was not applied according to the manufacturer's instructions, as it was not rinsed off, which could lead to skin irritation. Staff members, including an LPN and two CNAs, admitted to not knowing the resident was on EBP and found it difficult to identify residents on EBP without clear signage or communication from the facility. The Director of Nursing (DON) confirmed that the soap used required rinsing and acknowledged that improper use could cause skin irritation. The facility's policy on EBP and bed baths was reviewed, which outlined the necessity of gowns and gloves during high-contact care activities and the proper procedure for bed baths, including rinsing soap off the resident's skin.
Medication Administration and Storage Deficiencies
Penalty
Summary
The facility failed to ensure proper administration and storage of medications for residents. Specifically, two residents were observed self-administering nebulizer treatments without being assessed for their ability to do so safely. Resident #188 was seen self-administering a nebulizer treatment, and the Licensed Practical Nurse (LPN) confirmed that the resident had not been assessed for self-administration. Similarly, Resident #8 was observed receiving a nebulizer treatment without staff supervision, despite the requirement for a nurse to remain with the resident during the treatment. The Director of Nursing (DON) confirmed that no residents had been assessed to self-administer medications. Additionally, the facility failed to secure medication carts and controlled substances properly. An LPN left a medication cart unlocked in the hallway, and the DON confirmed that the cart should have been locked to prevent unauthorized access. Furthermore, a narcotic box containing controlled substances was found in a refrigerator with only one lock, contrary to the facility's policy requiring two locks for controlled substances. The DON confirmed that controlled substances should be behind two locks, and the facility's policy on medication storage was not followed.
Infection Control and PPE Deficiencies
Penalty
Summary
The facility failed to ensure proper storage and handling of respiratory mask tubing and nasal cannula tubing for two residents. In one instance, a respiratory mask was found on the floor and was placed back in the storage pouch without being cleaned, contrary to the facility's procedure. In another instance, nasal cannula tubing was observed hanging outside the storage pouch, which was confirmed to be inappropriate and posed a risk of infection. The Director of Nursing (DON) confirmed that the nasal cannula should be stored properly to prevent bacterial contamination. The facility also failed to ensure that dirty laundry was bagged and returned to the laundry room in a manner that prevents the spread of germs. A white laundry basket with unbagged dirty linens was found outside the clean laundry room doors. The Social Director, who placed the dirty linens there, was unaware of the proper process. The DON confirmed that all laundry should be bagged and placed in designated barrels to prevent the spread of germs. Additionally, the facility did not ensure that staff wore proper Personal Protective Equipment (PPE) and performed hand hygiene during perineal care and other high-contact activities. Staff were observed not changing gloves or performing hand hygiene during perineal care for two residents. Furthermore, staff failed to wear gowns and gloves while providing care to a resident on Enhanced Barrier Precautions (EBP). The DON confirmed that staff had been in-serviced on EBP and were aware of the residents on EBP. The facility also failed to store a resident's denture brush in a sanitary manner, as it was found resting on the porcelain of the sink, which could lead to contamination.
Failure to Maintain Resident Privacy During Wound Care
Penalty
Summary
The facility failed to protect the privacy and dignity of a resident when providing wound care. Resident #60, who has diabetes with diabetic nephropathy and a deep tissue injury to the left heel, was observed receiving wound care without the curtain being pulled or the door being closed. This incident occurred despite the resident being cognitively intact, as indicated by a score of 14 on the Brief Interview for Mental Status. The Treatment Nurse confirmed the lapse in maintaining the resident's privacy, and the Director of Nursing acknowledged that the door should be closed and/or the curtain pulled to ensure privacy. The facility's policy on dignity emphasizes that residents should be treated with respect and their privacy maintained at all times.
Failure to Include Oxygen Therapy and CPAP in Care Plan
Penalty
Summary
The facility failed to ensure the care plan for a resident with Acute and Chronic Respiratory Failure with Hypoxia included oxygen therapy and Continuous Positive Airway Pressure (CPAP) as ordered by a physician. The resident, who was cognitively intact, was observed on multiple occasions with an oxygen concentrator set at 3.0 liters per minute. However, the care plan revision did not document the use of oxygen therapy or CPAP, despite the physician's orders and the resident's dependence on supplemental oxygen. The Medication Administration Record for May 2024 indicated that the resident required oxygen every hour as needed for shortness of breath. Observations confirmed the oxygen concentrator settings, but the care plan lacked the necessary documentation. The Director of Nursing provided policies for CPAP/BiPAP support and oxygen administration, which outlined the procedures for administering oxygen and CPAP. However, these policies were not reflected in the resident's care plan, leading to the deficiency noted by the surveyors.
Failure to Secure Indwelling Catheter Tubing
Penalty
Summary
The facility failed to ensure a leg strap was in place to prevent trauma from an indwelling catheter for a resident with severe cognitive impairment and multiple medical diagnoses, including a urinary tract infection, heart failure, and lymphedema. The resident's care plan specified that the catheter tubing should be secured to the leg with an applicable device to prevent pulling and yanking. However, during observations and interviews, it was found that the catheter tubing was not secured, causing discomfort to the resident when being repositioned or moved out of bed. The resident reported feeling the catheter pulling during these times, and the surveyor confirmed the absence of a leg strap during an inspection of the tubing under the cover. Further observations during incontinent care provided by CNAs and the Infection Preventionist revealed that the catheter tubing became tight as the resident was turned, indicating it was still unsecured. The Infection Preventionist acknowledged that a leg strap should be in place to prevent the tubing from pulling. The Director of Nursing also confirmed that the catheter tubing should be held in place by a leg band and that it was the responsibility of all staff to ensure the leg strap was in place. Despite these acknowledgments, the deficiency persisted, leading to the resident experiencing discomfort and potential trauma from the unsecured catheter tubing.
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What surveyors actually found near you
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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 Prescott
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The Blossoms At Prescott Rehab & Nursing Center | 1.6 mi | ★★★★★ | 4 | 0 |
| Heather Manor Nursing And Rehabilitation Center | 16.7 mi | ★★★★★ | 0 | 0 |
| Murfreesboro Rehab And Nursing, Inc | 25.4 mi | ★★★★★ | 21 | 1 |
| Twin Rivers Rehabilitation And Healthcare Center | 27.5 mi | ★★★★★ | 10 | 0 |
| Nightingale At Arkadelphia | 27.7 mi | ★★★★★ | 6 | 0 |
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