Above average — CMS composite of the measures below.
A standard survey is most likely before around September 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 Apple Valley Village Health Care Center during CMS and state inspections, most recent first.
A resident who was NPO with Alzheimer’s dementia, severe protein/calorie malnutrition, and recent hospitalization for sepsis, pneumonia, and severe dehydration depended on tube feeding and scheduled free water flushes to meet daily fluid needs. After the RD obtained a telephone order from a PA to increase free water flushes to 225 ml four times daily and transcribed it into the MAR, nursing staff did not verify the order for approximately 35 hours, and scheduled flushes were not administered for about 48 hours, creating a potential 1350 ml fluid deficit. MAR entries showed missed or unrecorded flushes across multiple administration windows, while interviews with the DON, RNs, LPNs, and the HUC described inconsistent and delayed order verification practices, confusion over responsibility for processing orders, and a lack of routine auditing of order timeliness, all contributing to the failure to provide the ordered hydration.
A resident with cognitive impairment reported grievances about improper use of a mechanical lift and missing clothing items, which were not properly tracked or resolved by the facility. The facility lacked a formal grievance process, leading to unresolved concerns and inadequate communication with the resident's representatives.
A resident with moderate cognitive impairment and dependent on staff for activities of daily living was found with long, unkempt fingernails, indicating a failure in routine grooming and personal hygiene care. Despite the resident's request for nail clipping, the care plan lacked specific interventions for nail care, and there was no documentation of such care being offered or completed. Nursing staff interviews revealed that nail care was expected to be done weekly with baths, but it was not routinely documented unless refused, leading to the deficiency.
A resident with a history of anemia and decreased mobility developed a dry, flaking skin condition on their leg, which was not comprehensively assessed or monitored by the facility. Despite observations by staff, the condition was not documented in the resident's care plan or medical record, and no consistent treatment was provided. Interviews with nursing staff revealed a lack of communication and timely intervention, contrary to the facility's Skin Integrity policy.
A facility failed to consistently implement a restorative nursing program (RNP) for a resident, leading to potential mobility decline. The resident's care plan indicated a need for stand-by assistance and verbal cues for ambulation, but the RNP was not consistently offered or documented. Interviews revealed staff were unaware or forgot to offer the program, and documentation did not reflect refusals or consistent implementation.
A facility failed to document medical justification for a resident's indwelling catheter, despite the resident experiencing multiple UTIs and symptoms of dysuria. The resident's medical record lacked evidence of necessity for the catheter, and no trial removal was attempted since its placement in 2021. Staff interviews revealed assumptions about the resident's refusal to remove the catheter, and the director of nursing acknowledged the need for proper justification.
A resident with chronic pain and opioid dependency experienced severe pain despite medication management, as the facility failed to assess and implement non-pharmacological interventions. The resident reported pain levels of 8/10, affecting sleep and daily activities, and had multiple falls due to knee weakness. Staff interviews revealed a lack of comprehensive pain assessment, focusing mainly on medication rather than exploring alternative pain relief methods, contrary to the facility's pain management policy.
The facility failed to address dental concerns for two residents who voiced complaints. One resident reported unresolved issues with dentures causing trouble with chewing, but there was no evidence of action taken by the facility. Another resident expressed a desire for dentures, but the facility did not follow up on a previous dental visit where the resident showed interest in implant-supported dentures. The facility's policy required documentation of dental care plans, but there was a lack of communication and documentation, leading to the deficiency.
Untimely Processing of Tube-Feeding Water Flush Order Leading to Missed Hydration
Penalty
Summary
The deficiency involves the facility’s failure to timely process and implement a physician order for increased scheduled free water flushes for a resident who was NPO and dependent on tube feeding for hydration and nutrition. The resident had Alzheimer’s dementia, severe protein/calorie malnutrition, swallowing difficulties, and had recently been hospitalized for sepsis, pneumonia, and severe dehydration before returning to the facility. Her nutritional assessment identified that her estimated daily fluid needs were 1440–1800 ml, with approximately 821 ml provided by tube feeding formula and the remaining 619–979 ml expected from scheduled free water flushes and medication-related flushes. After readmission, she initially had an order for 150 ml free water flushes six times a day, and on 2/12/26, the RD assessed her fluid needs and obtained a telephone order from a PA to change the regimen to 225 ml free water flushes four times a day via feeding tube, discontinuing the 150 ml flushes. The RD transcribed the new flush order into the electronic MAR at 12:03 p.m. on 2/12/26, with administration times set for four time windows throughout the day. Based on this entry time, there was potential for the resident to receive the first 225 ml flush between 1:00 p.m. and 2:00 p.m. that day. However, the February MAR showed that the 1:00 p.m.–2:00 p.m. and 4:00 p.m.–6:00 p.m. administration windows on 2/12/26 were marked with an “x” symbol, and the 7:00 a.m.–8:00 a.m., 10:00 a.m.–11:00 a.m., and 1:00 p.m.–2:00 p.m. windows on 2/13/26 were blank, with the 4:00 p.m.–6:00 p.m. window on 2/13/26 documented as “Not Administered: Other Comment: pm shift.” The General Order audit report showed that the new flush order, entered at 12:03 p.m. on 2/12/26, was not verified by LPN-A until 11:16 p.m. on 2/13/26, approximately 35 hours after it was placed. The MAR further identified that the resident did not receive another scheduled free water flush until the morning of 2/14/26 between 7:00 a.m. and 8:00 a.m., following the last documented scheduled flush at 8:00 a.m. on 2/12/26, resulting in an approximate 48-hour gap in scheduled flush administration and a potential 1350 ml fluid deficit related to the untimely order processing. Interviews with staff revealed inconsistent and delayed order verification practices that contributed to the missed flushes. The RD stated she expected nurses to verify orders the same day and reported she alerted the resident’s primary nurse about the change but could not recall which nurse; she was unaware that multiple flushes were missed. The DON stated that orders entered around midday were expected to be verified within a couple of hours and that the resident’s flush order should have been verified in time for the late afternoon administration window; she acknowledged there was no routine audit process for order-processing timeliness and denied recent audits or identified trends. Multiple nurses and the HUC described a process in which orders were sometimes left unverified for extended periods, with some staff believing the HUC was primarily responsible for processing orders, and others reporting that orders, including dietary orders, could sit in bins or in pending status for days. LPN-A characterized the order process as a “disaster” and reported having encountered orders left unprocessed for up to a week. Staff, including the PA who wrote the order, indicated that the two-day delay in verification of the flush order was longer than expected and acknowledged that the resident, being NPO and dependent on tube feeding, needed the flush order implemented as soon as possible.
Failure to Track and Resolve Resident Grievances
Penalty
Summary
The facility failed to ensure that a resident's grievances were properly tracked and resolved through the established grievance process. A resident, identified as R55, who had moderate cognitive impairment and required assistance for transfers, reported concerns about staff using a mechanical lift improperly. The resident's representative witnessed staff using the lift independently, contrary to the care plan that required two staff members for transfers. Despite these concerns being communicated to the facility, there was no formal grievance filed, and the resident's representative was not updated on the resolution of the issue. Additionally, the facility did not document or address reports of missing clothing items for the same resident, R55. The resident's representative reported missing items to the staff, but there was no evidence of a formal report or investigation into the missing items. The Director of Social Services, responsible for tracking lost items, confirmed that no form had been completed for R55, indicating a lapse in the facility's process for handling such concerns. Interviews with staff revealed that there was a lack of clarity and consistency in the facility's grievance process. The Director of Nursing and the Director of Social Services both indicated that it was up to individual staff members to decide whether a formal grievance needed to be filed, and there were no official criteria for determining when a grievance should be documented. This lack of a structured process contributed to the failure to properly address and resolve the grievances raised by R55's representatives.
Failure to Provide Routine Nail Care for Resident
Penalty
Summary
The facility failed to provide routine grooming and personal hygiene care, specifically nail care, for a resident who was dependent on staff for such care. The resident, identified as having moderate cognitive impairment and requiring assistance with activities of daily living, was observed with long fingernails and dark-colored debris under the nails. Despite the resident expressing a need for help with nail clipping, the care plan lacked specific interventions for nail care, and there was no documentation of nail care being offered or completed in the resident's medical records, Medication Administration Record (MAR), or Treatment Administration Record (TAR). Interviews with nursing staff revealed that nail care was expected to be completed weekly with bathing schedules, but it was not routinely documented unless refused by the resident. Nursing assistants were responsible for nail care for non-diabetic residents, yet there was uncertainty about when the resident's nails were last clipped. The facility's policy indicated that nail care should be provided weekly and as needed, but this standard was not met for the resident in question, leading to the deficiency identified by surveyors.
Failure to Assess and Monitor Resident's Skin Condition
Penalty
Summary
The facility failed to comprehensively assess and monitor a developed skin condition for a resident, identified as R141, who had large areas of dry, flaking skin on their leg. Upon admission, R141's Minimum Data Set (MDS) indicated intact cognition and no current skin-related problems, but the Nursing Admission evaluation lacked spaces to record any skin conditions. Despite being at risk for skin integrity alteration due to medical conditions and decreased mobility, the care plan did not address the dry skin condition that developed. Observations and interviews revealed that R141 had a large, black-colored area on the swollen right thigh and dry, flaking skin extending down to the foot. The resident reported that the skin was itchy and sore, with no consistent treatment or monitoring. Nursing assistant NA-A confirmed the presence of dry skin and stated that no specific instructions were given for its care. The Comprehensive Skin Risk assessment and Visual Body Inspections failed to document the dry skin condition, and the Wound Management tracking in the electronic medical record lacked any specific monitoring or treatment. Interviews with nursing staff, including RN-C and unit managers RN-A and RN-B, indicated that the dry skin condition was not reported or assessed in a timely manner. RN-C noticed the condition but had not initiated treatment, while RN-A and RN-B were unaware of the issue until the day of the interview. The facility's Skin Integrity policy required immediate reporting and documentation of new skin alterations, but this was not followed, resulting in a lack of comprehensive assessment and intervention for R141's skin condition.
Failure to Implement Restorative Nursing Program
Penalty
Summary
The facility failed to consistently implement a restorative nursing program (RNP) for a resident, identified as R52, to prevent a possible decrease in mobility. R52's quarterly Minimum Data Set (MDS) indicated that the resident required maximal assistance for transferring and moderate assistance with bed mobility, and walking was not attempted. Although R52 received occupational and physical therapy during the look-back period, the resident was not on an RNP according to the MDS. However, R52's care plan indicated that the resident was supposed to be on an RNP, receiving stand-by assistance and verbal cues while ambulating 500 feet daily. The Point of Care History report showed that R52 completed the RNP only twice during a specified period, with multiple instances of the field being left unanswered and one occurrence documented as deferred due to condition. There was no indication in the medical record that R52 had been offered or refused the RNP during this time. Interviews with staff and the resident revealed further inconsistencies. R52 stated that since being discharged from physical therapy, the walking program was not offered. A physical therapist confirmed the importance of the RNP for maintaining R52's ability to walk. A nursing assistant was unsure if R52 was on an RNP and suggested that aides might not have been remembering to offer the program. The nurse manager confirmed that the documentation indicated R52 had not received the RNP consistently and did not include refusals. The director of nursing stated that instructions for the RNP were in the care plan and should have been documented in the Point of Care History, including any refusals. The facility's policy indicated that the RNP should have been entered into the care plan and scheduled for aides to complete, which was not consistently done in this case.
Lack of Medical Justification for Indwelling Catheter Use
Penalty
Summary
The facility failed to ensure appropriate medical justification for the continued use of an indwelling catheter for a resident who was cognitively intact and had a history of urinary tract infections and bladder spasms. The resident's electronic medical record lacked documentation of medical necessity for the catheter, despite the resident experiencing multiple UTIs in the past six months. A hospitalization note indicated the resident had been hospitalized due to a UTI caused by the Foley catheter, and a provider note suggested a trial discontinuation of the catheter, which was not followed up on during a subsequent provider visit. Interviews with facility staff revealed that the provider did not discuss the removal of the Foley catheter, assuming the resident would refuse, as the resident had done in the past. The nurse manager confirmed that no trial removal had been attempted since the catheter was placed in 2021, despite the resident experiencing symptoms of dysuria with the catheter in place. The director of nursing acknowledged the importance of having medical justification for the catheter's continued use and intended to work with the provider or urologist to address this issue. The facility's policy required medical justification for the initiation and continuation of indwelling catheter use.
Deficiency in Pain Management for Resident with Chronic Pain
Penalty
Summary
The facility failed to adequately assess and reassess non-pharmacological pain interventions for a resident, R95, who experienced chronic severe pain. Despite being cognitively intact and frequently reporting pain levels of 8/10, which interfered with sleep and daily activities, the facility did not document any attempts to identify or implement non-pharmacological interventions that could supplement medication management. R95's care plan, which had not been updated since 2020, included potential non-pharmacological interventions such as positioning, warm blankets, and ice packs, but there was no evidence these were offered or evaluated for effectiveness. R95's medical history included chronic pain syndrome and opioid dependency, and he was on a regimen of various pain medications, including cyclobenzaprine, hydrocodone-acetaminophen, Lyrica, meloxicam, and Suboxone. Despite this, R95 continued to report severe pain and had multiple falls, which were attributed to knee weakness. Interviews with staff revealed a lack of comprehensive assessment of R95's pain management needs, with staff focusing primarily on medication rather than exploring alternative pain relief methods. R95 expressed willingness to try different non-pharmacological interventions, such as aromatherapy or massage, but reported that staff had not inquired about his pain goals or preferences. The facility's policy on pain management emphasized a commitment to resident comfort through both pharmaceutical and non-pharmaceutical interventions. However, the documentation and interviews indicated a failure to adhere to this policy, as there was no evidence of a systematic approach to assessing and implementing non-pharmacological pain management strategies for R95. This oversight contributed to the ongoing severe pain experienced by R95 and his subsequent falls, highlighting a deficiency in the facility's pain management practices.
Failure to Address Dental Concerns for Residents
Penalty
Summary
The facility failed to address dental concerns for two residents, R106 and R65, who voiced complaints during the survey. R106, who had intact cognition, reported unresolved issues with her dentures, which were causing trouble with chewing. Despite these complaints, there was no evidence in R106's medical record that the facility had acted upon the loose-fitting denture or offered any dental appointment. The nursing admission and care conference summaries lacked documentation of any dental services offered or discussed, and the dietary staff did not communicate R106's concerns to the nursing staff. R65, who also had intact cognition, expressed a desire for dentures but reported that the facility staff had not discussed this with her. Although R65 had a dental visit where she expressed interest in implant-supported dentures, there was no follow-up documented in her medical record. The care conference summaries did not mention any follow-up on the dental visit, and it was only after the surveyor's inquiry that a progress note indicated R65 and her spouse decided not to pursue dentures. The facility's policy on ancillary services required social services to identify needs and goals for dental care upon admission and document the resident's plan in the care conference summary. However, the facility failed to provide documentation supporting their involvement or awareness of the follow-up needed from R65's dental appointment. The lack of communication and documentation led to the deficiency in providing timely and appropriate dental services for the residents.
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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 Apple Valley
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ebenezer Ridges Geriatric Care Center | 3.2 mi | ★★★★★ | 4 | 0 |
| Martin Luther Care Center | 6.4 mi | ★★★★★ | 0 | 0 |
| The Estates At Bloomington Llc | 7.6 mi | ★★★★★ | 12 | 0 |
| Presbyterian Homes Of Bloomington | 7.7 mi | ★★★★★ | 1 | 0 |
| Trinity Care Center | 7.8 mi | ★★★★★ | 6 | 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.