Above average — CMS composite of the measures below.
The next survey window likely opens around February 2027
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 Sylvan Court during CMS and state inspections, most recent first.
Outdated medication was administered from a stock bottle in the med cart when a TMA gave a resident Docusate Sodium without checking the expiration date first. The TMA later saw the bottle was expired, and an LPN confirmed the medication should have been replaced at the end of the prior month. The resident had received doses from the outdated bottle for a total of 24 administrations, and the DON and pharmacist stated staff were expected to follow the 5 rights and not give outdated medication.
The facility failed to store frozen food items off the floor in both walk-in freezers, affecting all residents. Observations revealed various frozen foods on the floor, contrary to the facility's policy requiring storage at least 6 inches above the floor. The dietary manager and administrator acknowledged the issue, citing storage space limitations and potential over-ordering as contributing factors.
A facility failed to accurately code a resident's medication on the MDS assessment. The resident, diagnosed with diabetes, was incorrectly noted to have received an insulin injection, while the physician orders indicated a weekly dose of Ozempic, a non-insulin medication. The MDS coordinator initially misunderstood the coding requirements but later confirmed the error after reviewing the RAI manual. No policy on assessment accuracy was provided by the survey's end.
The facility failed to complete a gradual dose reduction (GDR) attempt annually or document a rationale for no GDR for two residents on psychotropic medications. Despite recommendations and policies, the facility did not attempt GDR or document clinical contraindications, leading to the continued use of potentially unnecessary medications.
Outdated medication administered from stock bottle
Penalty
Summary
The facility failed to ensure that one medication, Docusate Sodium (Colace) 100 mg soft gels, was not outdated before administration to a resident receiving 2 capsules by mouth every morning. During observation, a TMA retrieved the medication from the stock bottle in the medication cart, removed 2 soft gel capsules, and administered them to the resident without checking the expiration date first. After the medication was given, the TMA examined the bottle and saw that the printed expiration date was February 2026, and she acknowledged that she had not checked the expiration date before administration. A subsequent observation with an LPN confirmed the expiration date on the bottle and identified that the medication should have been replaced at the end of February. The LPN removed the bottle from the medication cart and took it to the medication room for disposal, and stated she would notify the MD and complete a Medication Variance Communication report. The TMA and LPN confirmed the resident had been receiving the medication from the outdated stock bottle for a total of 24 doses. The DON stated staff were expected to follow the 5 rights of medication administration and not administer an outdated medication, and the facility pharmacist stated expired medication should have been identified and replaced to avoid administration of an outdated medication.
Improper Storage of Frozen Food Items in Walk-In Freezers
Penalty
Summary
The facility failed to ensure that frozen food items were stored safely off the floor in both of its walk-in freezers located in the kitchen. During an observation, multiple boxes of frozen food, including sweet potato fries, corn bread, Swedish meatballs, cheese tortellini, potato cubes, breaded chicken, and chili, were found on the floor under the bottom shelf in the first walk-in freezer. Similarly, the second walk-in freezer had frozen fruit smoothies, enchiladas, assorted pies, queso triangles, slider buns, hoagie buns, and muffin batter stored on the floor. The dietary manager acknowledged awareness of the improper storage practice and attributed it to storage issues due to additional dietary requirements of residents, which necessitated more freezer space. The administrator was also aware of the concerns and suggested that over-ordering might have contributed to the problem. The facility's undated Food Storage Standards policy mandates that all foods be stored on a shelf at least 6 inches above the floor.
Inaccurate Medication Coding on MDS Assessment
Penalty
Summary
The facility failed to ensure accurate coding of medications on the Minimum Data Set (MDS) assessment for a resident diagnosed with diabetes. The resident's admission MDS assessment incorrectly identified that the resident received an insulin injection during the look-back period. However, the resident's current physician orders did not include insulin but rather a once-weekly dose of Ozempic, a non-insulin medication used to improve blood sugar control. The MDS coordinator initially believed that Ozempic could be coded as insulin if used to treat diabetes but later confirmed, upon reviewing the Resident Assessment Instrument (RAI) manual, that Ozempic should not have been coded as insulin. The facility did not provide a policy related to the accuracy of assessments by the end of the survey.
Failure to Attempt Gradual Dose Reduction for Psychotropic Medications
Penalty
Summary
The facility failed to complete a gradual dose reduction (GDR) attempt annually or document a rationale for no GDR for two residents reviewed for unnecessary medications. Resident R2, who had diagnoses including hypertension, neurogenic bladder, dementia, seizure disorder, traumatic brain injury, and depression, was on Sertraline and Olanzapine. Despite being on these medications for an extended period, no GDR was attempted, and no clinical contraindication was documented. Interviews with staff revealed that while R2 had a history of aggressive behavior, he had not displayed such behaviors recently, and his medications had not been adjusted accordingly. The psychiatrist and primary physician did not document any rationale for continuing the current doses without attempting a GDR, and the pharmacist's recommendations were not forwarded to the psychiatrist as required. The director of nursing and the administrator acknowledged the oversight and agreed that a GDR should have been attempted or documented as contraindicated annually. The mental health provider also failed to document the rationale for continuing the current medication doses during the last visit, despite being open to a potential dose reduction in the future. Resident R11, who had severe cognitive impairment and a diagnosis of dementia and depression, was on mirtazapine and escitalopram. The facility did not attempt a GDR for R11's antidepressants, and there was no documentation of a clinical contraindication. The pharmacist's recommendations for a GDR were not implemented, and the care plan did not address the use of mirtazapine as an appetite stimulant. Interviews with staff indicated that R11's wife refused the GDR attempts, and the medical provider stated that R11's treatment plans required the wife's approval. Despite this, there was no documentation of the refusals or any attempts to address the issue with the medical provider. The registered nurse was unsure if the use of mirtazapine for appetite stimulation had been communicated to the medical provider. The facility's policies on psychotropic medications and GDR were not followed, as evidenced by the lack of documented attempts or clinical contraindications for GDR in both residents. The pharmacist's reviews and recommendations were not adequately communicated to the relevant medical providers, and the care plans did not reflect the necessary interventions for medication management. The failure to adhere to these policies resulted in the continued use of potentially unnecessary medications without proper justification or attempts to reduce the doses.
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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 Canby
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Hendricks Community Hospital | 15.6 mi | ★★★★★ | 0 | 0 |
| Johnson Memorial Hospital & Home | 18.7 mi | ★★★★★ | 2 | 0 |
| Madison Healthcare Services | 21.9 mi | ★★★★★ | 10 | 0 |
| Clarkfield Care Center | 23.7 mi | ★★★★★ | 5 | 0 |
| Avera Morningside Heights Care Center | 30.5 mi | ★★★★★ | 6 | 1 |
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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.