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 Wentz Living Center during CMS and state inspections, most recent first.
Staff failed to follow hand hygiene and glove-use standards during toileting care for two residents and during medication preparation for one resident. CNAs used the same gloves across multiple tasks, including incontinence care, transfers, and handling resident items, without washing hands between glove changes, and a medication aide handled a pill with a bare finger without performing hand hygiene or using gloves.
A resident sustained a fall with fractures due to the use of an improperly sized sling during a mechanical lift transfer. The facility failed to assess the resident for the appropriate sling size, leading to the resident slipping out of the sling. Staff interviews confirmed the use of a medium-sized sling, which was not suitable for the resident, and the administrative nurse acknowledged the need for proper assessments.
Failure to Follow Hand Hygiene and Glove Use Standards
Penalty
Summary
The facility failed to follow infection control and prevention standards during toileting care for 2 sampled residents and during medication preparation for 1 supplemental resident. Review of facility policy showed that staff were expected to wash hands after removing gloves and to perform hand hygiene prior to medication pass, with gloves used as needed after proper hand hygiene. During observation of Resident #2, two CNAs assisted with toileting care, and one CNA used the same gloves to provide incontinence care, pull up the resident’s pants, operate a mechanical lift, remove the sling, place a blanket on the resident, and hand the resident a glass of water before removing gloves and performing hand hygiene. During observation of Resident #5, two CNAs used gowns and gloves for toileting care, transferred the resident with a mechanical lift, removed the soiled brief, emptied the urine collection bag, raised the resident from the toilet, applied barrier cream, placed a new brief, adjusted the resident’s pants, and transferred the resident to a wheelchair without performing hand hygiene after removing soiled gloves and before applying clean gloves. During medication preparation for Resident #16, a medication aide opened a medication bottle and used a bare finger to obtain a pill without performing hand hygiene prior to medication preparation and without applying gloves before touching the medication.
Improper Sling Size Leads to Resident Fall and Injury
Penalty
Summary
The facility failed to prevent an accident involving a resident who sustained a fall with fractures due to the use of an improperly sized sling during a full body mechanical lift transfer. The incident occurred because the facility did not assess the resident for the appropriate sling size, which is crucial for safe transfers. The facility's policy on mechanical dependent lifts, dated December 2019, did not include guidelines for assessing the proper sling size for residents dependent on mechanical lifts. This oversight led to the resident slipping out of the sling and falling to the floor, resulting in fractures. Interviews with staff members revealed that a medium-sized sling was used during the transfer, which was not suitable for the resident. A staff member admitted to using the sling that was with the lift without assessing its appropriateness for the resident. The administrative nurse acknowledged that residents should have been assessed for sling sizes. The failure to assess and provide staff with the necessary information and education regarding transfers resulted in a fall with major injury for the resident.
Removal Plan
- Therapy or nursing will assess sling size per policy developed
- Therapy or nursing staff will communicate to the charge nurse of appropriate sling size, a comment order will be entered into provider orders, it will be care planned in the activities of daily living section and sent to the Kardex for easy certified nurse aides (CNAs) viewing
- Education will be provided to all nursing/CNA staff. Each CNA or nurse will be educated by reviewing the policy, care plan, Kardex and signing the education form
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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 Napoleon
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Wishek Living Center | 19.5 mi | ★★★★★ | 0 | 0 |
| Strasburg Nursing Home | 31.5 mi | ★★★★★ | 6 | 0 |
| Ashley Medical Center Nursing Home | 36.9 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.