Above average — CMS composite of the measures below.
A standard survey is most likely before around October 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 Oceana County Medical Care Facility during CMS and state inspections, most recent first.
Multiple residents did not receive medications as ordered, and medication administration was inaccurately documented. Issues included missed doses of critical medications, discrepancies between medication removal logs and MARs, and failure to perform or document required pre-administration assessments such as blood pressure checks. These deficiencies were confirmed by facility leadership and were not in line with established policies or nursing standards.
A resident who was dependent on staff for transfers and required assistance was repeatedly left without access to a call light, despite care plan instructions. Staff interviews confirmed that the call light was not placed within reach after the resident was assisted back to the room, leaving the resident unable to request help when needed.
The facility failed to maintain adequate ventilation in the AU Unit and 200 Hallways, leading to stagnant, humid air and lingering odors in resident rooms and restrooms. Observations and interviews revealed that the ventilation system was not functioning properly, with restroom vents lacking suction and air return ducts having little to no air pressure. The Maintenance Director acknowledged a potential blower motor issue and the absence of a preventative maintenance checklist.
The facility failed to communicate residents' code status to their guardians or responsible parties in a timely manner and did not maintain copies of advanced directives in the medical records. A resident's POA was not informed of the code status until 1.5 months after the resident was deemed unable to make decisions. Another resident's POA was informed five months late, and a third resident's guardian was informed 27 days after appointment. The facility did not ensure advanced directives were obtained and maintained, risking residents' wishes not being honored.
Failure to Administer and Document Medications per Physician Orders
Penalty
Summary
The facility failed to ensure that medications were administered in accordance with physician orders and that medication administration was accurately documented for six out of seven residents reviewed. For one resident with a history of kidney transplant, the anti-rejection medication Tacrolimus was not administered on multiple occasions due to confusion over medication packaging and discrepancies in the medication cart. The nurse responsible signed the Medication Administration Record (MAR) as if the medication had been given, despite not administering it, which was later substantiated by low Tacrolimus levels in the resident. Other residents experienced similar issues with medication administration and documentation. One resident with quadriplegia did not have a controlled substance (Valium) properly documented as removed from the medication card, even though the MAR indicated it was administered, and there was no documentation for withholding the dose. Another resident with dementia had a dose of Ativan not documented as removed from the medication card, while the MAR showed it was given, with no supporting documentation for withholding. A resident with chronic pain was prescribed two tablets of Tramadol at bedtime, but only one tablet was documented as removed on several occasions, while the MAR reflected administration of two tablets, and there was no documentation for dose changes or omissions. Additionally, residents prescribed medications requiring pre-administration assessments, such as blood pressure checks for antihypertensive and orthostatic hypotension medications, did not consistently have these assessments performed or documented. In several instances, blood pressure readings from previous times or days were used to justify medication administration, or medications were held without documentation of the required assessment or rationale. These failures were confirmed by facility leadership and were not in accordance with facility policy or professional standards of nursing practice.
Failure to Ensure Call Light Accessibility for Dependent Resident
Penalty
Summary
A deficiency occurred when staff failed to ensure that a dependent resident's call light was consistently left within reach, as required by the resident's care plan. The resident, who had diagnoses including diabetes, heart failure, and weakness, was dependent on staff for transfers and required the call light to be accessible when alone in the room. On multiple occasions, the resident was observed sitting in a recliner with the call light either out of reach or not visible, and the resident reported being unable to locate or use the call light to request assistance. Interviews with staff confirmed that the call light should have been left within the resident's reach after being assisted back to the room, but this was not done. One CNA acknowledged forgetting to place the call light within reach after assisting the resident, and another confirmed the resident's need for staff assistance and the importance of call light accessibility. These actions and inactions resulted in the resident being unable to call for help as directed by the care plan.
Ventilation Deficiency in AU Unit and 200 Hallways
Penalty
Summary
The facility failed to maintain adequate ventilation in the AU Unit and the 200 Hallways, resulting in stagnant, muggy, and humid air, as well as lingering odors in resident rooms and restrooms. Observations on multiple occasions revealed that the air in the halls and resident rooms felt stagnant, with some rooms having persistent bathroom odors. Family members also reported that the rooms were consistently hot and stagnant, indicating a chronic issue with the ventilation system. Further investigation by maintenance personnel confirmed that the restroom vents in several rooms were not producing any suction, and the air return ducts in various rooms had little to no air pressure. The Maintenance Director acknowledged a potential issue with the blower motor on the unit and noted the absence of a preventative maintenance checklist. Despite checking the roof, no visible problems with the ventilation system were identified, suggesting an unresolved issue affecting the air quality in the facility.
Failure to Communicate Code Status and Maintain Advanced Directives
Penalty
Summary
The facility failed to provide timely communication of residents' code status to their designated guardians or responsible parties and did not maintain copies of advanced directives in the medical records for several residents. For Resident #32, the facility did not have documentation of the resident's advanced directives for medical decisions in the medical record, despite the resident being deemed unable to make medical decisions. The responsible party, identified as the power of attorney (POA) for medical care, was not informed of the resident's code status until 1.5 months after the resident was determined to be unable to make medical decisions. The facility's Director of Nursing (DON) and Social Worker (SW) attempted to obtain the necessary documentation from the responsible party, but it was not provided by the time of the survey. Resident #64 also lacked documentation of advanced directives for medical decisions in the medical record, and the responsible party was not informed of the resident's code status until approximately five months after the resident was determined to be unable to make medical decisions. The facility eventually received a document designating the responsible party as the patient advocate, but this was only added to the medical record on the day of the survey. For Resident #76, the facility did not document that the resident's guardian was informed of the resident's Do Not Resuscitate (DNR) wishes until 27 days after the guardian was appointed. The facility's policy required that residents or their representatives provide advanced directives at the time of admission, but the facility failed to ensure these documents were obtained and maintained in the residents' medical records, leading to the potential for residents' wishes not being honored.
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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 Hart
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Oakview Medical Care Facility | 18.1 mi | ★★★★★ | 9 | 0 |
| Medilodge Of Ludington | 18.4 mi | ★★★★★ | 13 | 0 |
| Optalis Health & Rehabilitation Of Whitehall | 21 mi | ★★★★★ | 26 | 0 |
| Regency At Fremont | 27.4 mi | ★★★★★ | 3 | 0 |
| Newaygo Co Medical Care Facility | 27.5 mi | ★★★★★ | 0 | 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 July 2026) and official state health department websites.