Below average — CMS composite of the measures below.
The next survey window likely opens around May 2027
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Haven Nursing Center during CMS and state inspections, most recent first.
A resident with unspecified dementia, anxiety, and recurrent major depressive disorder had a BIMS score indicating moderate cognitive impairment and was receiving Abilify. The S3ADON confirmed the medication was an antipsychotic and that the resident did not have an appropriate diagnosis to support its use.
A resident with severe cognitive impairment and multiple chronic conditions had a scabbed area on the right upper buttock that was not identified or documented on weekly skin assessments. A family member raised concern about an area on the resident’s bottom, and later assessment by nursing staff confirmed the wound; the LPN, DON, and ADON were unaware of it, while a CNA reported she had seen an abrasion and told the nurse.
A facility failed to document a change of condition for a resident with repeated low BP and low pulse readings, and failed to document physician notification for another resident’s accucheck of 517 when the order required notification for results over 400. The residents had significant medical histories including dementia, heart disease, COPD, and diabetes, and the ADON confirmed the missing documentation.
A pharmacist failed to identify and report medication review irregularities for a resident receiving Abilify and Lasix. The resident had no documented diagnosis supporting Abilify use, and the chart lacked evidence of edema monitoring while on Lasix. The pharmacist did not notify the attending MD, Medical Director, or DON during monthly pharmacy reviews.
A resident with dementia, anxiety, and recurrent major depressive disorder had a BIMS score indicating moderate cognitive impairment and was ordered Lasix 20 mg daily with monitoring for edema. Review of the MARs showed no documented edema monitoring while the resident was receiving the diuretic, and the ADON confirmed the missing documentation.
Food was not stored and monitored under sanitary conditions. Surveyors observed garlic bread, french toast, and hamburger buns open to air and not sealed properly in the freezer, and the kitchen had no documented steam table, refrigerator, or freezer temperatures for several days. An S4DM confirmed the open packages and missing temperature documentation.
Unlocked Biohazard Waste Closet: The facility failed to maintain its infection prevention and control program when the biohazard waste storage closet was observed unlocked and accessible to residents and the public, including several filled sharps containers. The Administrator later confirmed the biohazard door should remain locked and not be accessible to residents or the public.
A resident with intact cognition and multiple chronic conditions had Mupirocin ointment left on the over-bed table for a skin tear treatment order. Staff observed the medication at the bedside, and the resident said the nurse had left it there the day before. The ADON confirmed the resident had not been assessed to self-administer meds and should not have meds at the bedside.
Two residents, one with an existing stage 3 pressure injury and another at moderate risk for pressure ulcers, were repeatedly observed sitting in wheelchairs without pressure-relieving cushions. Both residents had significant health conditions and required extensive assistance, yet staff confirmed that appropriate pressure-reducing devices were not provided as required by facility policy.
A resident with multiple chronic conditions and significant weight loss did not receive timely follow-up from facility staff to implement a registered dietician's recommendation for an appetite stimulant. The DON confirmed that the facility failed to follow up with the physician to address the resident's nutritional needs.
The facility did not ensure the medical director attended quarterly QAA meetings, as shown by missing signatures on meeting rosters and administrator confirmation of the absence.
A resident with severe cognitive impairment and a history of neck surgery was repeatedly observed in a geri chair with her feet dangling and unsupported, despite her care plan indicating the need for monitoring and support. Multiple staff, including an LPN/Clinical Manager and the DON, confirmed that her legs and feet should have been supported, but this was not provided.
A medication storage deficiency was identified when a fluticasone inhaler was found left on a resident's bedside table. The resident confirmed the inhaler was hers and that a nurse had left it there. Both an LPN and the DON acknowledged that the inhaler should not have been left unsecured in the resident's room.
The facility failed to respect a resident's request for a more textured diet, despite his cognitive competence to make his own medical decisions. The resident repeatedly expressed dissatisfaction with the pureed diet and refused to eat it. Both the ADON and DON acknowledged the resident's competence and confirmed that a waiver should have been offered, which was not done.
A resident with severe cognitive impairment and significant weight loss did not receive a prescribed diabetic nutritional supplement twice daily as ordered. Staff confirmed the supplement was not administered, despite the resident's critical need for nutritional support.
A resident received the psychotropic medication Vistaril beyond the 14-day limit without a documented end date or rationale, despite recommendations from the consultant pharmacist. The facility's DON and ADON confirmed the oversight.
Inappropriate Antipsychotic Use Without Supporting Diagnosis
Penalty
Summary
The facility failed to ensure a resident was free of chemical restraints by not ensuring there was an appropriate diagnosis to support the use of an antipsychotic medication for Resident #13. The resident was admitted with diagnoses including unspecified dementia without behavioral, psychotic, or mood disturbances, generalized anxiety disorder, and major depressive disorder recurrent. The quarterly MDS showed a BIMS score of 10, indicating moderate cognitive impairment, and also indicated receipt of antipsychotic and diuretic medications. The resident’s physician orders included Abilify 2.5 mg by mouth daily, and during interview the S3ADON confirmed the resident was receiving Abilify, which is an antipsychotic medication, and that the resident did not have an appropriate diagnosis for its use.
Failure to Identify and Document a Resident’s Buttock Wound
Penalty
Summary
The facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice by not identifying a wound on the resident’s right upper buttock in a timely manner. The resident had diagnoses including chronic systolic congestive heart failure, right hip osteoarthritis, atherosclerotic heart disease, old myocardial infarction, unspecified protein-calorie malnutrition, and major depressive disorder. The annual MDS showed a BIMS score of 7, indicating severe cognitive impairment, and that the resident required substantial-maximal assistance with most ADLs. The resident was assessed as at moderate risk for pressure ulcers, with no current pressure ulcers and no other skin problems identified. During an interview, the resident’s family member stated there was an area on the resident’s bottom that they did not think was being treated. A later head-to-toe skin assessment with nursing staff revealed a small scabbed area on the resident’s right upper buttock, and the LPN present was not aware of it. The DON and ADON also confirmed the scabbed area and reported that no staff had informed them of it. A CNA stated she had seen an abrasion on the resident’s right upper buttock while working with the resident and had reported it to the resident’s nurse, though she was unsure of the nurse’s name. Weekly skin assessments from 05/07/2026 through 06/04/2026 contained no documentation of any skin conditions or wounds, while the wound assessment later documented a new in-house acquired wound on the right gluteus described as a scab measuring 1.39 cm by 1.22 cm.
Failure to Document Change of Condition and Physician Notification
Penalty
Summary
The facility failed to ensure licensed nurses had the specific competencies and skill sets necessary to care for resident needs by not documenting a change of condition for a resident with repeated low blood pressure and low pulse readings. Resident #84 was admitted with diagnoses including dementia, anxiety, diabetes mellitus, heart disease, myocardial infarction, COPD, hyperlipidemia, dysphagia, and muscle weakness, and had a BIMS score of 3 indicating severe cognitive impairment. The vital signs record showed blood pressure readings of 80/69, 130/49 with a pulse of 41, 95/55 with a pulse of 56, 70/51, and 96/51 over several days, but the medical record did not contain documented evidence of a change of condition related to the low blood pressure and/or low pulse. The ADON confirmed there was no documented evidence of this change of condition. The facility also failed to document physician notification for a high blood sugar reading for Resident #10, who had a diagnosis of diabetes and an order for accuchecks before meals and at bedtime with notification to the physician for results greater than 400. The MAR showed an accucheck result of 517 on the morning of 06/05/2026, but there was no documentation in the progress notes that the physician was notified of the result. The ADON confirmed there was no documentation that the physician was notified of the accucheck result greater than 400.
Pharmacist Failed to Report Medication Review Irregularities
Penalty
Summary
The licensed pharmacist failed to complete and report irregularities identified during monthly drug regimen reviews for Resident #13, who was admitted with diagnoses including unspecified dementia without behavioral, psychotic, or mood disturbances, generalized anxiety disorder, hypertension, chronic obstructive pulmonary disease, and major depressive disorder. The resident had orders for Abilify 2.5 mg daily and Lasix 20 mg daily, but the record did not show an appropriate diagnosis for Abilify use and did not contain documented monitoring for edema while the resident was receiving Lasix. Review of the pharmacy reports dated 04/29/2026 and 05/28/2026 showed the pharmacist did not notify the facility, the attending physician, the Medical Director, or the DON about the missing diagnosis for Abilify or the lack of edema monitoring for Lasix, and S3ADON confirmed these omissions.
Failure to Monitor for Edema While Resident Received Lasix
Penalty
Summary
Resident #13 was admitted on 04/17/2023 with diagnoses including unspecified dementia without behavioral, psychotic, or mood disturbances, generalized anxiety disorder, and major depressive disorder recurrent. The resident’s quarterly MDS showed a BIMS score of 10, indicating moderate cognitive impairment, and also indicated receipt of a diuretic medication. A physician’s order dated 09/26/2025 directed Lasix 20 mg by mouth daily with monitoring for edema. Review of the May and June 2026 MARs showed no documented evidence that edema monitoring was completed while the resident was receiving Lasix. During interview on 06/10/2026 at 11:40 a.m., S3ADON confirmed that Resident #13 received Lasix and that there was no documented evidence of monitoring for edema.
Food Storage and Temperature Monitoring Deficiencies
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food under sanitary conditions. During an observation on 06/08/2026 at 7:50 a.m., surveyors found one package of garlic bread and french toast stored in the freezer open to air and not sealed properly, and one package of hamburger buns also open to air and not sealed properly. Review of the temperature logs showed no documented evidence of steam table food temperatures from 06/03/2026 through 06/07/2026. Further review of the logs showed no documented evidence of refrigerator or freezer temperatures from 06/03/2026 through 06/07/2026. At 8:00 a.m. on 06/08/2026, S4DM confirmed that the food item packages were open to air and not sealed properly, and that there was no documentation of steam table, refrigerator, or freezer temperatures for the stated dates.
Unlocked Biohazard Waste Closet
Penalty
Summary
The facility failed to provide an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment when biohazardous waste was left accessible to unauthorized personnel. Observations of the biohazardous waste storage closet on 06/08/2026 at 11:24 a.m. and 06/09/2026 at 11:38 a.m. showed the closet was unlocked and its contents were accessible to residents and the public, including several filled sharps containers. During an interview on 06/10/2026 at 10:05 a.m., the Administrator confirmed the biohazard door should remain locked and should not be accessible to residents or the public.
Failure to Assess Resident for Self-Administration of Medication
Penalty
Summary
The facility failed to assess a resident for self-administration of medications despite the resident having intact cognition, with a BIMS score of 15, and a bedside tube of Mupirocin ointment found in the room. The resident had diagnoses including rheumatoid arthritis, hypothyroidism, anxiety, edema, hypertension, and depression, and had a skin tear to the left shin with an order to clean the wound, apply Mupirocin ointment, and cover it with a non-adherent dressing daily and as needed until healed. Observations on the resident's room showed the Mupirocin ointment on the over-bed table, and the resident stated the nurse had left the ointment in the room the day before. The ADON was notified and confirmed the resident should not have medications at the bedside and had not been assessed to self-administer medications.
Failure to Provide Pressure-Relieving Devices for Residents at Risk of Pressure Ulcers
Penalty
Summary
The facility failed to provide necessary pressure ulcer prevention and treatment interventions for two residents, as required by their own policy and professional standards of practice. One resident with multiple comorbidities, including chronic kidney disease, diabetes, and morbid obesity, was identified as high risk for pressure ulcers and was receiving treatment for a stage 3 pressure injury and a suspected deep tissue injury. Despite this, the resident was repeatedly observed in her wheelchair without a pressure-relieving cushion, and staff confirmed that such a device should have been in place due to her current pressure ulcer. Another resident, also with significant health issues such as morbid obesity, reduced mobility, and muscle weakness, was assessed as being at moderate risk for developing pressure ulcers. This resident was observed multiple times sitting in a wheelchair without a pressure-relieving cushion and reported sitting in the wheelchair most of the day without being offered a cushion, despite expressing discomfort. The DON confirmed that a cushion should have been provided to reduce the risk of pressure ulcer development for this resident.
Failure to Timely Implement RD Recommendation for Appetite Stimulant
Penalty
Summary
A deficiency was identified when the facility failed to maintain acceptable parameters of nutritional status for a resident with multiple diagnoses, including muscle wasting, muscle weakness, cognitive communication deficit, COPD, chronic atrial fibrillation, Alzheimer's disease, and vitamin deficiency. The resident experienced a significant weight loss, dropping from 179.0 pounds to 162.5 pounds over a two-month period. The registered dietician (RD) recommended an appetite stimulant for the resident and communicated this recommendation to the physician. However, the facility did not follow up with the physician in a timely manner to implement the RD's recommendation, as confirmed by the Director of Nursing (DON).
QAA Committee Meetings Lacked Required Medical Director Attendance
Penalty
Summary
The facility failed to hold quarterly Quality Assessment and Assurance (QAA) meetings with all required committee members present, as evidenced by the absence of the medical director at each of the reviewed meetings. Record review showed that the medical director's signature was not recorded on the attendance rosters for QAA meetings held on 01/30/2025, 11/12/2024, 07/30/2024, and 03/28/2024. This was confirmed during an interview with the administrator, who acknowledged the medical director was not present for these meetings.
Failure to Provide Proper Lower Extremity Support in Geri Chair
Penalty
Summary
A deficiency was identified when a resident with Alzheimer's disease, atherosclerotic heart disease, hypertension, and major depressive disorder, who was severely cognitively impaired and required extensive two-person assistance with most activities of daily living, was repeatedly observed seated in a geri chair without proper support for her lower extremities. The resident's care plan indicated a need for monitoring due to a history of neck surgery with residual stiffness and specified that a geri chair may be used as needed for her condition. Multiple observations over several days showed the resident in the day area with her feet dangling and unsupported while in the geri chair. These observations were confirmed by both a LPN/Clinical Manager and the Director of Nursing, who acknowledged that the resident's legs and feet should have been supported when she was in the chair. The facility failed to provide care in accordance with professional standards of practice and the resident's person-centered care plan.
Medication Storage Deficiency: Inhaler Left at Bedside
Penalty
Summary
A medication storage deficiency occurred when a fluticasone inhaler, prescribed to a resident, was found on the resident's bedside table during an observation. The resident confirmed that the inhaler belonged to her and stated that a nurse had left it at her bedside. Subsequent interviews with an LPN and the Director of Nursing confirmed that the inhaler should not have been left in the resident's room and should have been securely stored. This incident involved the failure to ensure that drugs were accessible only to authorized personnel, as required by facility policy and professional standards.
Failure to Respect Resident's Dietary Preferences
Penalty
Summary
The facility failed to treat a resident with respect and dignity by not honoring his request for a more textured diet. The resident, who was admitted with multiple diagnoses including dysphagia following cerebral infarction and severe protein-calorie malnutrition, had a Brief Interview for Mental Status (BIMS) score of 15, indicating independent cognitive skills for daily decision-making. Despite this, the facility changed his diet from minced and moist to pureed texture without his consent. The resident repeatedly expressed his dissatisfaction with the pureed diet and refused to eat it, as documented in the nurses' notes and observed during meal times. Interviews with the resident confirmed that he did not want a pureed diet and that he was capable of making his own medical decisions. Both the Assistant Director of Nursing (ADON) and the Director of Nursing (DON) acknowledged the resident's cognitive competence and his right to make his own decisions. The DON further confirmed that the facility should have offered the resident a waiver to eat his preferred diet texture, which was not done, leading to the deficiency in respecting the resident's rights and dignity.
Failure to Administer Diabetic Nutritional Supplement
Penalty
Summary
The facility failed to ensure a resident maintained acceptable parameters of nutrition by not providing a diabetic nutritional supplement as ordered by the physician. Resident #27, who had severe cognitive impairment and was dependent on staff for all activities of daily living, had an active order for a diabetic house supplement twice a day due to significant weight loss. Despite this order, the April 2024 Electronic Medication Administration Record (EMAR) revealed no documentation of the supplement being administered since it was ordered on 04/04/2024. Interviews with staff confirmed the deficiency. An LPN acknowledged that the supplement was not administered, and the Assistant Director of Nursing confirmed that the resident should have received the supplement as ordered. The resident's weight records showed a significant decline, further emphasizing the importance of the prescribed nutritional intervention that was not provided.
Failure to Limit PRN Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure that a resident was free from unnecessary medication use. Specifically, the physician did not limit the use of the psychotropic medication Vistaril to a 14-day period as required. The resident, who was admitted with multiple diagnoses including bipolar disorder, major depressive disorder, and anxiety disorder, had an active physician order for Vistaril 50 mg to be administered every 12 hours as needed for anxiety. Despite a recommendation from the consultant pharmacist to limit the PRN use of Vistaril to 14 days and to provide a specific duration or stop date, the physician assistant denied the gradual dose reduction and failed to provide a rationale for continuing the medication beyond the recommended period. The resident received Vistaril on multiple occasions throughout April 2024 without an end date or documented rationale for its continued use. An interview with the Director of Nursing and Assistant Director of Nursing confirmed that the psychotropic medication should not have been administered as needed for more than 14 days. The Assistant Director of Nursing acknowledged that the physician assistant continued the PRN psychotropic medication past the 14-day limit without a documented end date or rationale. This oversight led to the resident receiving unnecessary medication, which is a violation of the facility's medication management policies.
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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 Columbia
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Northeast La War Veterans Home | 13.4 mi | ★★★★★ | 5 | 0 |
| Legacy Nursing And Rehabilitation Winnsboro | 21.8 mi | ★★★★★ | 1 | 0 |
| Plantation Manor Nursing And Rehab Center, Llc | 23.2 mi | ★★★★★ | 0 | 0 |
| Guest House Nursing And Rehabilitation | 25.8 mi | ★★★★★ | 1 | 0 |
| Mary Anna Nursing Home | 26.5 mi | ★★★★★ | 8 | 2 |
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