Average — CMS composite of the measures below.
The next survey window likely opens 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 Hilltop Manor Nursing Center during CMS and state inspections, most recent first.
Incorrect Sling Used During Mechanical Lift Transfer: A resident with MS and total transfer dependence was moved with a full-body mechanical lift using a sling that was too small and rated for less weight than the resident. The sling ripped during the transfer, causing the resident to fall to the floor and sustain a left femur fracture and pelvic fractures.
Meals Served Below Required Holding Temperature: Dietary staff prepared pureed fried chicken and placed it uncovered in the steam table, where its temperature dropped from 195.6 degrees F to 132.7 degrees F before serving. An interview confirmed the chicken should have been held at 135 degrees F or higher, and the facility did not provide a policy related to safe, appetizing food temperatures.
Infection control failures involved EBP, hand hygiene, equipment storage, and catheter care. Two CNAs provided direct care to a resident with a feeding tube without the required EBP PPE, moved a mechanical lift between residents without sanitizing it, and failed to perform hand hygiene after removing PPE. Staff also failed to wash hands before applying PPE during tube feeding care. In addition, nebulizer masks and oxygen tubing were stored unsafely, and a resident’s catheter tubing was observed dragging on the floor and being rolled over by a wheelchair.
Failure to invite residents and their representatives to care plan meetings. Two residents had no documentation of care plan meetings in the EMR, and both stated they were not invited. An Administrative Nurse said invitations were reportedly sent by letter, but no copies or EMR documentation were kept, and another nurse confirmed residents do not attend care plan meetings and there was no documentation that families were invited.
A resident with intact cognition and diagnoses including anxiety and DM had Mucinex and Flonase at the bedside and reported self-administering them, but the chart lacked an assessment, care plan entry, and physician order for those medications to be kept in the room for self-administration. Staff confirmed only budesonide had been approved for bedside self-administration, while the resident’s record showed inconsistent self-administration findings and no documentation for the OTC meds.
Wheelchair Foot Platform Not Kept Attached: A resident with intact cognition and significant physical impairments, including quadriplegia and spinal stenosis, was observed sitting in an electric wheelchair with her legs dangling unsupported because the foot platform had been removed and not reinstalled. An LPN and an administrative nurse stated the foot platform or pedals should remain attached at all times for safety and circulation, and the facility policy called for reasonable accommodation of resident needs and individualization of the physical environment.
A resident with intact cognition and significant medical diagnoses, including quadriplegia and CKD, was documented as full code in the EHR and care plan, but she stated she had signed a DNR in the past and did not want CPR. She reported staff never asked her about code status or advance directives. Interviews with nursing staff and the facility policy showed the admitting nurse was responsible for confirming code status and requesting advance directive copies on admission.
A resident with Parkinson's disease, dysphagia after CVA, dementia, and anxiety received trazodone PRN for insomnia without the required 14-day stop date on two orders. The resident had severely impaired cognition on MDS, and the chart showed trazodone use as a psychotropic medication tied to anxiety, agitation, and depression. Facility staff confirmed PRN psychotropic meds should have a 14-day stop time, but the facility policy did not address that requirement.
Incomplete EMR Documentation for Schizophrenia Diagnosis: The facility failed to maintain adequate EMR documentation supporting a resident’s paranoid schizophrenia diagnosis. The resident also had dementia and severely impaired cognition, but the care plan lacked schizophrenia documentation and the record did not include physician findings or assessments supporting the diagnosis. Staff could not explain why the diagnosis appeared in the chart, and the facility did not provide a policy for professional standards of care related to diagnosing schizophrenia for antipsychotic use.
Failure to provide grooming assistance: A resident with dementia, paranoid schizophrenia, and DM had care plan directions for nail trimming and facial hair removal, but was observed with long, broken fingernails and facial hair stubble on multiple occasions. Staff gave inconsistent accounts about who should shave residents and who should trim diabetic residents’ nails, and the resident’s grooming needs were not consistently met.
Wheelchair Assistance Provided Without Foot Pedals: Staff assisted two residents in wheelchairs without foot pedals attached and without the residents’ feet secured on the pedals. A CNA pushed one resident while the resident’s feet touched the floor, and an LN and an activity staff member assisted another resident while the resident held her feet up during locomotion. Staff interviews stated residents should have pedals attached and feet secured before assisted wheelchair movement, and the facility’s policy did not address applying pedals before assistance.
A facility failed to identify causal factors and implement effective interventions to prevent falls for two residents, resulting in multiple falls and injuries. One resident with Parkinson's disease experienced several falls leading to fractures and hospital visits, while another resident with congestive heart failure had multiple falls without thorough investigations or care plan updates. The facility's lack of adequate supervision and intervention updates placed residents at risk for further falls.
A resident with Parkinson's disease and other conditions experienced multiple unwitnessed falls resulting in injuries, including a fractured clavicle and a need for hip surgery. Despite the facility's policy requiring the reporting of suspected neglect, these incidents were not reported to the State Agency. The care plan lacked evidence of corrective actions, and the administrative staff did not recognize the falls as potential neglect, placing the resident at risk for ongoing issues.
A resident with severe cognitive impairment and multiple health conditions was transferred to the hospital without the facility providing the required written notice of transfer to the resident or their representative. Although phone notifications were made, the facility did not adhere to its policy of providing written notice, risking miscommunication and potential missed healthcare opportunities.
The facility failed to update care plans for two residents, leading to multiple falls and injuries. One resident with Parkinson's disease experienced several falls, including fractures, without effective interventions added to the care plan. Another resident with congestive heart failure and vertigo also had multiple falls, some with injuries, but the care plan lacked fall prevention strategies. The facility's policy required care plan revisions, but these were not implemented, placing residents at risk.
Incorrect Sling Used During Mechanical Lift Transfer
Penalty
Summary
The facility failed to ensure an environment free from accident hazards when staff used the wrong full-body mechanical lift sling for a resident who was dependent on staff for all transfers and locomotion. The resident had diagnoses including progressive multiple sclerosis and muscle spasms, had intact cognition with a BIMS score of 15, and weighed 255.2 pounds. The care plan directed staff to use total assistance of two staff and a green full-body sling for all lift transfers, but on the day of the incident a CNA retrieved the top sling from a pile without verifying that it was the correct sling for the resident. During the transfer, two CNAs used a sling that was too small for the resident and had a maximum weight capacity of 150 pounds. While the resident was being moved with the mechanical lift, the sling ripped at the strap and the resident fell to the floor. Staff statements described the resident falling onto his left side while still attached to the lift, with blood noted from his feet and arms. The resident was found on the floor under the lift with the broken sling, and staff documented skin tears and bleeding wounds. The resident was sent to the ED for evaluation, and imaging showed a left femur fracture with displacement and angulation, as well as nondisplaced fractures of the superior and inferior pubic rami. The facility’s investigation documented that the sling used was the wrong size for the resident, and staff interviews confirmed that the sling had been taken from the top of a pile without checking sizing. The incident was cited as isolated immediate jeopardy.
Meals Served Below Required Holding Temperature
Penalty
Summary
The facility failed to ensure that meals were served at a safe and appetizing temperature. During observation, Dietary CC prepared four servings of pureed fried chicken with a cooked temperature of 195.6 degrees Fahrenheit, then scraped the chicken into a small metal container and placed it uncovered in the steam table. When the pureed chicken was rechecked in the steam table prior to serving, its temperature had dropped to 132.7 degrees Fahrenheit. The chicken and other food items for the meal were then served after all holding temperatures were checked. During interview, Dietary Staff CC verified that chicken should be served at 135 degrees Fahrenheit or higher because it should have a holding temperature of 135 degrees Fahrenheit, and confirmed that the pureed chicken was served at 132.7 degrees Fahrenheit. The facility did not provide a policy related to safe, appetizing food temperatures.
Infection Control Failures With EBP, Hand Hygiene, Equipment Storage, and Catheter Care
Penalty
Summary
The facility failed to utilize Enhanced Barrier Precautions (EBP) during direct care for a resident with a feeding tube. On 12/29/25 at 08:08 AM, two CNAs transferred R3 from bed to recliner with a mechanical lift without the required EBP PPE. CNA Q then removed the lift from R3’s room and pushed it into R12’s room without sanitizing it. During the same observation, R23’s catheter drainage bag was placed on the mechanical lift sling at shoulder level, and CNA Q removed gown and gloves and wheeled R23 to the dining area without performing hand hygiene. CNA P also removed gown and gloves and exited R23’s room with trash without performing hand hygiene, and then returned the mechanical lift to the storage area without cleaning it. The facility also failed to ensure adequate hand hygiene and PPE use during personal care for R3. On 12/29/25 at 10:36 AM, LN G and CMA R applied gowns and gloves before direct care for R3’s tube feeding, but neither washed hands before applying PPE. During interview, CNA P stated she had not applied a gown for R3’s direct cares until she was educated that morning, and CNA Q stated she had not been wearing gowns for direct cares for residents on EBP except for R23 prior to that day. LN G reported she expected CNAs to wear all PPE required for EBP and said staff had been trained on EBP. The facility further failed to store respiratory equipment and manage catheter tubing in a sanitary manner. On 12/28/25, R30’s nebulizer mask was observed lying directly on the nightstand attached to the medication chamber with clear liquid, and R30’s oxygen nasal cannula was wrapped around the wheelchair handle. R1’s nebulizer mask was observed unbagged on the bedside table, and there was no date on R1’s oxygen nasal cannula or nebulizer equipment. On 12/29/25 at 10:10 AM, R23’s catheter tubing was observed lying directly on the floor in front of the wheelchair wheel, and the wheelchair rolled over the tubing while therapy personnel were present. The facility’s infection control policy stated that hand hygiene is to be followed for direct resident contact and that common equipment must be cleaned and disinfected before use by another resident, but the facility did not provide a policy for EBP or catheter care.
Failure to Invite Residents and Representatives to Care Plan Meetings
Penalty
Summary
The facility failed to ensure residents were given the opportunity to participate in the development and implementation of their person-centered plan of care when staff did not invite two residents or their responsible parties to care plan meetings. R30’s EMR showed Quarterly MDS assessments dated 08/25/25 and 11/25/25, but there was no documentation of a care plan meeting in the prior six months. During interview, R30 stated she was not invited to any care plan meeting. R1’s EMR showed an admission MDS dated 11/03/25, but there was no documentation of a care plan meeting in the prior two months. R1 stated she did not know what a care plan meeting was and had not been invited to one since admission. Administrative Nurse F stated invitations to care plan meetings were sent by letter to the responsible party and given to the resident at the facility, but no copy of the letter was kept and no EMR documentation was made showing the invitations or when meetings were held. She also stated R30 had a BIMS score of 13 and that she did not have a signed care plan sheet for R30 or the responsible party. She reported there was no signed care plan sheet for R1 and the responsible party because R1’s daughter had not been at the facility. Administrative Nurse D stated residents at the facility do not go to care plan meetings and confirmed there was no documentation showing families were invited. The facility policy stated every reasonable effort would be made to accommodate attendance of the resident and/or resident representative, and if unable or unwilling to attend, documentation of efforts made to accommodate attendance must be in the medical record.
Failure to Assess and Order Bedside Self-Administration of Medications
Penalty
Summary
The facility failed to assess a resident for the ability to safely self-administer Mucinex and Flonase and failed to ensure there was an order allowing those medications to be kept at the bedside for self-administration. The resident had diagnoses of anxiety and DM, an admission BIMS score of 13 indicating intact cognition, no behaviors or depression, and was documented as alert and oriented. Her care plan did not include self-administration of medications, and the only self-administration assessment in the record addressed budesonide inhalation suspension, which was approved to be kept in the room for self-administration. The resident’s physician orders did not include Mucinex or Flonase and did not include an order to keep either medication at the bedside. One self-administration assessment documented that she needed assistance with storing medications in a secure location, opening and closing medication containers, and telling time for medication administration, while a later assessment documented she was fully capable in those areas. During observation, the resident had Mucinex tablets and Flonase on her bedside table and stated she self-administered them because she had a cold. Staff interviews confirmed that residents were not allowed to keep medications in their rooms unless assessed and care planned for self-administration, and that nothing was documented for Mucinex or Flonase.
Wheelchair Foot Platform Not Kept Attached
Penalty
Summary
The facility failed to ensure Resident 23's foot platform remained attached to her electric wheelchair. Resident 23's EHR documented diagnoses including neuromuscular dysfunction of the bladder, chronic kidney disease, spinal stenosis, and quadriplegia. Her 5-day MDS showed a BIMS score of 15, indicating intact cognition, and documented that she was dependent on staff for all cares except eating, which required supervision/setup assistance. Her baseline care plan documented that she utilized a manual wheelchair. During an observation, Resident 23 was seen sitting in her electric wheelchair with her legs dangling unsupported from the seat. When interviewed, she stated therapy staff had removed the foot platform from her wheelchair the day before and nobody had reinstalled it. A licensed nurse stated residents who used electric wheelchairs should have the foot platform or pedals attached at all times to prevent their legs from dangling and to support proper circulation. An administrative nurse also stated residents with electric wheelchairs should have the foot platform or pedals attached at all times for safety concerns. The facility policy stated it would evaluate and make reasonable accommodations for a resident's individual needs and preferences and individualize the resident's physical environment.
Failure to Confirm Advance Directive and Code Status
Penalty
Summary
The facility failed to obtain valid advance directives or assess the end-of-life wishes of a resident with intact cognition. The resident’s EHR documented diagnoses of neuromuscular dysfunction of the bladder, CKD, spinal stenosis, and quadriplegia. The 5-Day MDS showed a BIMS score of 15, indicating intact cognition, and documented that the resident was dependent on staff for all cares except eating, which required supervision/setup assistance. The baseline care plan and physician orders identified the resident as full code. During interview, the resident stated she had signed a DNR document in the past and was able to describe potential injuries from resuscitative efforts. She said she did not want to endure that pain or discomfort and reported that facility staff had not asked her whether she was full code or had a DNR. Staff interviews indicated that an admitting nurse was responsible for confirming code status with the resident and/or representative and requesting copies of advance directives, and that if code status was unknown an assessment would be performed to obtain the information. The facility’s Advance Directives policy stated residents and/or representatives would be asked on admission if they had advance directives and that discussions would be documented, with copies placed in the resident record if provided.
Failure to Apply 14-Day Stop Time for PRN Psychotropic Medication
Penalty
Summary
The facility failed to ensure a 14-day stop time for PRN psychotropic medication use for Resident 5. Review of the electronic health record showed Resident 5 had diagnoses of Parkinson's disease, dysphagia following cerebral infarction, dementia, and anxiety, and the Minimum Data Set documented severely impaired cognition with BIMS scores of 3 and 4. The psychotropic Drug Use Care Area Assessment noted the resident received trazodone without documented adverse reactions or side effects, and the care plan identified use of antidepressant medications related to anxiety, agitation, and depression. Medication records showed trazodone oral tablet orders dated 10/27/25 for 50 mg, including one-half tablet every 24 hours PRN insomnia at bedtime and one tablet every 24 hours PRN insomnia at bedtime, and both orders lacked a 14-day stop date. Those orders were discontinued on 12/09/25. A later trazodone order for one-half tablet at bedtime for insomnia was written for 14 days and later discontinued on 12/22/25. Interviews with consultant and administrative staff confirmed that PRN psychotropic medications should have a 14-day stop time, and the facility's undated policy did not address the required 14-day stop time for PRN psychotropic medication use.
Incomplete EMR Documentation for Schizophrenia Diagnosis
Penalty
Summary
The facility failed to provide services that met professional standards of quality when R4’s EMR did not contain appropriate documentation supporting the diagnosis of paranoid schizophrenia. R4’s record showed diagnoses of paranoid schizophrenia and dementia, with a significant change MDS documenting a BIMS score of three, a CAA stating R4 was oriented to herself only, and care plan information describing her own form of communication, periods of agitation, and reliance on rosary beads and prayer. However, the care plan lacked documentation regarding schizophrenia, and older physician documentation in the record did not consistently include paranoid schizophrenia as a diagnosis or supporting clinical findings. The EMR contained a 12/20/19 physician note documenting a change in diagnosis of risperidone to paranoid schizophrenia and a 04/09/24 physician note listing paranoid schizophrenia, but the record lacked physician documentation, clinical findings, and assessments supporting the addition of that diagnosis. During observation, R4 was seated in her room with visible facial hair stubble, long broken fingernails, and repetitive speech while swaying back and forth. Staff interviews showed Administrative Nurse F was responsible for documenting diagnoses in the EMR, while Administrative Nurse E and Administrative Staff A could not explain why paranoid schizophrenia appeared in the diagnosis tab or confirm a thorough history for the diagnosis. The facility did not provide a policy for professional standards of care in diagnosing schizophrenia for use with antipsychotics.
Failure to Provide Grooming Assistance
Penalty
Summary
The facility failed to offer and provide assistance with nail care and facial hair removal for a resident with paranoid schizophrenia, dementia, and diabetes mellitus. The resident’s MDS documented severely impaired cognition with a BIMS score of 3, and the care plan directed staff to trim fingernails during weekly skin assessments, cleanse fingernails on bath days, notify the nurse if nails needed trimming because the resident was diabetic, maintain a clean and well-groomed appearance, and shave the chin if needed. During observations, the resident was seen with visible facial hair stubble around the jawline, chin, and upper lip, and with long, broken fingernails on multiple occasions. Although one observation later showed the resident clean-shaven, the fingernails remained unchanged. Staff interviews showed inconsistent practice regarding shaving and nail care: CNAs reported they would shave residents on shower or bath days or when needed, but also stated they could not cut fingernails for diabetic residents and would notify the nurse instead. Nursing staff stated they expected CNAs to shave residents who needed assistance and nurses to trim diabetic residents’ fingernails, while the administrative nurse stated staff should shave residents every shower day or as needed and nurses should cut diabetic residents’ fingernails.
Wheelchair Assistance Provided Without Foot Pedals
Penalty
Summary
The facility failed to ensure an environment free from accident hazards when staff assisted two residents in wheelchairs without the foot pedals attached and without the residents’ feet secured on the pedals. During an observation, one resident was pushed by a CNA from the common area down the hall and into the resident’s room while the wheelchair had no foot pedals attached and the resident’s feet were touching the floor. During another observation, a second resident was assisted by an LN and later by an activity staff member while seated in a wheelchair without foot pedals attached; the resident held her feet up during the assisted locomotion. During interviews, staff stated that residents in wheelchairs should have pedals attached and their feet secured on the pedals before staff-assisted wheelchair locomotion. An LN stated that residents should not be assisted unless the wheelchair had pedals and the resident’s feet were securely placed on them, and that the facility kept spare wheelchair pedals for use when needed. An administrative nurse stated the facility’s expectation was that staff should not assist residents in wheelchairs unless foot pedals were present and appropriately fitted and secured. The facility’s undated Incidents and Accidents policy did not address applying pedals to a wheelchair prior to staff-assisted wheelchair locomotion.
Failure to Prevent Falls and Update Care Plans
Penalty
Summary
The facility failed to identify causal factors for falls, provide adequate supervision, and implement effective interventions to prevent avoidable accidents for a resident with multiple falls over various dates. This resident, who had diagnoses including Parkinson's disease and major depressive disorder, experienced several falls resulting in fractures, contusions, increased pain, and multiple hospital visits. The care plans for this resident were not updated with interventions by the Interdisciplinary Team to prevent further falls, despite repeated incidents. Another resident, with diagnoses including congestive heart failure and benign paroxysmal positional vertigo, also experienced multiple falls. The facility did not complete thorough fall investigations, including root cause analyses, for this resident's falls. The care plan for this resident lacked interventions to prevent further falls, despite the resident having an unsteady gait and poor balance. The facility's Accident/Incident Committee policy was not effectively implemented, as evidenced by the lack of adequate interventions and updates to care plans following falls. The facility's failure to provide adequate supervision and implement effective interventions resulted in actual harm to one resident and placed another resident at risk for further falls and injuries.
Failure to Report Unwitnessed Falls as Potential Neglect
Penalty
Summary
The facility failed to identify and report multiple unwitnessed falls of a resident, referred to as R32, as potential neglect to the State Agency (SA) as required. R32, who had a history of Parkinson's disease, major depressive disorder, generalized anxiety disorder, and a nondisplaced intertrochanteric fracture of the left femur, experienced several falls resulting in injuries, including a fractured clavicle and a need for surgical repair of the left hip. Despite these incidents, the facility did not recognize them as possible neglect and did not report them to the SA. R32's care plan documented an increased risk for falls due to advancing Parkinson's disease and impetuous behavior. The care plan included interventions such as frequent monitoring, use of a walker, and assistance with mobility. However, the facility's records showed that R32 had multiple unwitnessed falls, including one where he tripped on a slippery floor and another where he was found on the floor with a bulge to his left thigh. These incidents were not reported as potential neglect, and the care plan lacked evidence of corrective actions or interventions to prevent further falls. The facility's policy on abuse, neglect, and exploitation required the reporting of suspected abuse or neglect to the SA and other authorities. Despite this policy, the administrative staff did not report R32's unwitnessed falls with major injuries, believing there was no neglect or abuse. This failure to report placed R32 at risk for unidentified and/or ongoing abuse or neglect, as the facility did not follow its own policy or state requirements for reporting such incidents.
Failure to Provide Written Transfer Notice
Penalty
Summary
The facility failed to provide written notice of transfer as soon as practicable to a resident or their representative for facility-initiated transfers and/or discharge. The resident, identified as R13, had a diagnosis of congestive heart failure, hypertension, and sepsis, and was documented to have severely impaired cognition, requiring substantial assistance for activities of daily living. Despite these needs, the facility did not complete the required discharge Minimum Data Set and lacked staff direction regarding discharge in the resident's care plan. On a specific date, a nurse noted frank blood in the resident's brief and, following a physician's order, transferred the resident to the hospital. Although a bed hold authorization form was signed by the resident's representative, the facility could not provide the required written notification of transfer/discharge. Interviews with facility staff revealed that while phone notifications were made to the resident's family, no written form of transfer or discharge was provided, contrary to the facility's policy that required such notice to be given in a language and manner understandable to the resident and their representative.
Failure to Update Care Plans for Fall Prevention
Penalty
Summary
The facility failed to revise the care plans for two residents, R32 and R22, who experienced multiple falls, some resulting in injuries. R32, diagnosed with Parkinson's disease, major depressive disorder, and other conditions, had a history of falls with injuries, including fractures. Despite several falls documented in the electronic medical record, the care plan for R32 was not updated with effective interventions to prevent further falls. The care plan lacked corrective actions noted in the fall investigation summaries, such as ensuring non-skid socks were worn, monitoring R32's whereabouts, and providing therapy services. R22, diagnosed with congestive heart failure, glaucoma, and benign paroxysmal positional vertigo, also experienced multiple falls, some resulting in injuries. Despite having intact cognition and requiring supervision with transfers and walking, R22's care plan lacked interventions to address fall prevention. The fall investigations for R22 documented unwitnessed falls, some resulting in injuries, but lacked root cause analyses and updates to the care plan with new interventions. The facility's policy required the interdisciplinary team to evaluate and revise care plans based on the resident's condition and response to treatment. However, the care plans for R32 and R22 were not updated with necessary interventions to prevent further falls, placing both residents at risk for ongoing falls and injuries due to uncommunicated care needs.
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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 Cunningham
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Grand Plains Skilled Nursing By Americare | 15.7 mi | ★★★★★ | 3 | 0 |
| Pratt Health And Rehab | 16.3 mi | ★★★★★ | 6 | 0 |
| The Wheatlands Health Care Center | 16.8 mi | ★★★★★ | 0 | 0 |
| Leisure Homestead At Stafford | 23.6 mi | ★★★★★ | 32 | 0 |
| Prairie Sunset Home Inc | 24.7 mi | ★★★★★ | 0 | 0 |
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