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 Capitol Hill Skilled Nursing And Therapy during CMS and state inspections, most recent first.
Uncovered Dumpsters With Missing Doors and Lids: Surveyors observed that 2 of 3 dumpsters had no functioning side door or lid and were left open, with flying insects in and around the dumpsters. The facility policy required tight-fitting lids and that containers be kept covered at all times. The DS stated the dumpsters had been missing these parts for about a year and a half and that the issue had been reported to the Administrator, but no action had been taken.
Failure to Provide Usable Specialized Call Light: A resident with dementia and upper-extremity impairment was supposed to have a specialized alarm, but staff repeatedly placed it incorrectly by pinning it to clothing or putting the device in the resident’s hand without the string. The resident could not reach or trigger the alarm during observations, and staff acknowledged the resident was not able to use a regular call light and that the alarm had been placed wrong.
A resident with anxiety disorder and intact cognition had an active PRN Xanax order for anxiety with no end date listed. Facility policy required PRN anxiolytics, including Xanax, to have an initial 14-day stop date, and the NP, MD, and DON all confirmed the order should have included a stop date.
Delayed Reporting of Abuse Allegation: A resident with moderate cognitive impairment and a history of bone cancer reported that a CNA was rough during incontinence care. The hospice nurse informed facility leadership, but the allegation was not reported to the state survey agency within the required 2-hour timeframe; the DON and Administrator acknowledged the delay.
Staff were not trained on the proper use of a resident's specialized pull-cord alarm. A resident with dementia, hemiplegia/hemiparesis, moderate cognitive impairment, and upper-extremity impairment could not trigger the alarm when staff placed it in the resident's hand, and multiple NAs and an LPN said they had not been trained on how to use it. The DON and Administrator confirmed staff had not been trained, and the Administrator stated the facility had no policy regarding accommodation of residents' needs.
Unlocked Medication Cart Left Unattended: A CMA, while being trained by an LPN, left a medication cart unlocked while administering meds in a resident’s room about 55 feet away. The cart contained OTC items and resident meds, including Eliquis, metoprolol, methocarbamol, and furosemide. The CMA and LPN later acknowledged the cart had been unlocked, and the PC observed the storage issue.
A resident with chronic respiratory failure and moderate cognitive impairment was found without access to their call light, which was placed out of reach while they were in a wheelchair. The resident was unable to call for help and needed ice water. A CNA confirmed the facility's policy to keep call lights within reach and rectified the situation by pinning the call light to the resident's blanket.
A facility failed to accurately code the MDS for a resident with end-stage renal disease who received dialysis three times a week. The resident's care plan documented the dialysis treatment, but the quarterly MDS assessment did not reflect this. The MDS Coordinator later confirmed the oversight, acknowledging the inaccuracy.
A facility failed to remove expired medication from circulation, as observed in the medication storage room. A card of Zoloft 100 mg, labeled for a resident with recurrent depressive disorders, was found expired despite procedures for rotating stock and removing outdated medications. The DON and ADON confirmed the oversight.
A facility failed to follow enhanced barrier precautions for a resident at risk of infection due to a PEG tube and MDRO. An LPN performed PEG tube care without wearing a gown, despite the presence of an EBP sign and available gowns. The LPN misunderstood the requirements, believing only handwashing was necessary. The DON confirmed that both gown and gloves were required, highlighting a lapse in the facility's infection control program.
A facility failed to ensure a clean environment for a resident, as moderate dust buildup was observed on the ceiling vent in the resident's room. Despite a housekeeping policy requiring regular cleaning of ceiling vents, the vent had not been cleaned, and a housekeeper admitted to neglecting this task.
A resident with dementia and personal care needs did not have a scheduled care plan meeting due to the departure of the responsible social worker. The facility failed to inform the resident's family about the missed meeting or reschedule it. The last care plan meeting was held months earlier, and the lack of communication contributed to the deficiency.
A resident with dementia and a UTI experienced a delay in urinalysis specimen collection due to a failure in sending the initial sample to the lab. The specimen, collected for lab tests ordered by a physician, remained in the ice box until a family inquiry prompted a new collection. The DON confirmed the need for timely specimen handling.
A facility failed to report an abnormal urinalysis result to the provider in a timely manner for a resident with dementia and a UTI. The urine specimen was collected and reported positive, but there was no documentation of provider notification on the report date. The delay in notification was confirmed by staff interviews, and the facility lacked a lab policy for notifying providers of abnormal results.
A resident with chronic obstructive pulmonary disease required a new upper denture plate, but the facility failed to follow up on a physician's order for a dental referral. Despite the resident reporting the loss of their dentures and a physician issuing an order, the resident had not seen a dentist. The LPN passed the order to the social services worker, but no appointment was made. The activities director, who helped with social services, was unaware of the need for a dental visit as the previous social service worker did not act on the order.
A resident with diabetes and intact cognition was observed without a privacy curtain in their room, which they expressed a desire for. An LPN confirmed that privacy curtains should be used but acknowledged the absence of one in the resident's room.
Uncovered Dumpsters With Missing Doors and Lids
Penalty
Summary
The facility failed to ensure that 2 of 3 dumpsters were kept covered at all times, contrary to its policy titled, Safe Facilities and Pest Management, which stated that containers should have tight-fitting lids and be kept covered at all times. During an observation of the garbage receptacle area, surveyors noted that Dumpster #1 had no side door to close it and trash was openly accessible, while Dumpster #2 did not have a functioning lid and was left open. Flying insects were observed in and around both dumpsters. On a later observation with the Dietary Supervisor and the Regional Dietary Consultant, Dumpster #2 still had no side door, no functioning lid, and flying insects were again seen in and around the dumpster. The Dietary Supervisor stated the dumpsters had been without a side door or functioning lid for about a year and a half and said she had informed the Administrator, but nothing had been done. The Regional Dietary Consultant and the Administrator both stated their expectation was for the dumpsters to have functioning doors and lids that could be securely closed, and the Administrator acknowledged no one had been called to replace the dumpsters.
Failure to Provide Usable Specialized Call Light
Penalty
Summary
The facility failed to reasonably accommodate the needs and preferences of Resident #30 by not ensuring the resident had a usable specialized call light. Resident #30 was admitted with diagnoses including dementia and hemiplegia and hemiparesis following cerebrovascular disease affecting the left non-dominant side. The quarterly MDS dated 05/23/2026 showed a BIMS score of 8, indicating moderate cognitive impairment, and noted impairment on both sides of the upper extremities. The care plan identified the resident’s call light alternative as a clip alarm, but the resident stated they were supposed to have a call light in their hand, and the surveyor did not observe one in the resident’s hand during observation. During multiple observations and interviews, staff placed the pull-cord alarm incorrectly by pinning it to the resident’s clothing or placing the alarm device in the resident’s hand without the string, and the resident was unable to reach or initiate the alarm. A NA stated the resident was not able to use a regular call light but had a hand-held alarm, yet the resident could not trigger it when asked to try. Another NA stated the resident was not able to initiate the alarm when the blue part was placed in the resident’s hand, and that other staff had been placing the call light in the resident’s hand instead of the string. The DON stated she expected residents to have a call light they could use to request assistance, and the Administrator stated she expected staff to properly place a resident’s call light that was appropriate for the resident.
PRN Xanax Ordered Without Required Stop Date
Penalty
Summary
The facility failed to ensure that an as-needed antianxiety medication was limited to a 14-day stop date for one resident. Resident #59 was admitted with a history of anxiety disorder and had a quarterly MDS showing a BIMS score of 13, indicating intact cognition. The resident’s active order summary showed Xanax 0.25 mg by mouth every 12 hours as needed for anxiety, ordered on 01/28/2026, with no end date specified. Facility policy titled Appendix 19: Medications Requiring Behavior & Side Effect Monitoring stated PRN anxiolytics could only have an initial 14-day stop date and could not be continued indefinitely. Xanax was listed as an anxiolytic medication in that policy. During interviews, the NP, MD, and DON each reviewed the order and confirmed that PRN Xanax should have had a stop date, and the DON stated she expected PRN Xanax to have a stop date. The Administrator stated she was not involved in the process of PRN medications and stop dates.
Delayed Reporting of Abuse Allegation
Penalty
Summary
The facility failed to ensure an allegation of abuse involving Resident #72 was reported to the state survey agency within the required timeframe. The facility policy titled, Reports to State and Federal Agencies, stated alleged violations involving abuse, neglect, exploitation, or mistreatment are to be reported immediately, but no later than 2 hours after the allegation is made if the events involve abuse or result in serious bodily injury. Resident #72 was admitted on 11/06/2025 and had a history of malignant neoplasm of bone. A significant change MDS with an ARD of 12/17/2025 showed a BIMS score of 10, indicating moderate cognitive impairment. According to the incident report, Resident #72 told hospice staff during the evening hours of 12/17/2025 that a CNA was rough during incontinence care. The hospice nurse reported the allegation to facility staff, who then informed the DON and Administrator. The incident report prepared by the DON and dated 12/18/2025 at 4:00 PM documented notification of the physician, resident's family member, local law enforcement, and the nurse aide registry at that time. The Fax Transmission Report showed the allegation was reported to the state survey agency on 12/18/2025 at 7:31 PM. During interviews, the DON and Administrator stated abuse allegations were supposed to be reported within 2 hours of staff becoming aware of them, and the Administrator acknowledged the initial report was not submitted to the state survey agency within 2 hours.
Staff Not Trained on Resident's Specialized Pull-Cord Alarm
Penalty
Summary
The facility failed to educate staff on the proper use of a pull-cord alarm for Resident #30, who had diagnoses of dementia and hemiplegia and hemiparesis following cerebrovascular disease affecting the left non-dominant side. The resident's quarterly MDS showed a BIMS score of 8, indicating moderate cognitive impairment, and also noted impairment on both sides in the upper extremities. The care plan identified the resident's call light alternative as a clip alarm. During observation, a nurse aide pinned the pull-cord alarm to the resident's clothing and later placed the alarm without the string in the resident's hand, but the resident was unable to trigger it. The nurse aide stated she believed the resident could use the alarm with a thumb and said she had not received training on the specialized call light, learning only from other staff. Another nurse aide, an LPN, and another nurse aide each stated they had not received training on the pull-cord alarm used by the resident. The DON and Administrator also stated staff had not been trained on the alarm, and the Administrator stated the facility did not have a policy regarding accommodation of residents' needs.
Unlocked Medication Cart Left Unattended
Penalty
Summary
The facility failed to ensure that the 200 Hall medication cart was kept locked when it was out of sight of staff authorized to access it. During a concurrent observation and interview, a CMA being trained by an LPN was observed leaving the medication cart unlocked while administering medications in a resident’s room approximately 55 feet away from the cart. The cart contained over-the-counter medications in the top drawer, including aspirin, vitamins, stool softeners, glucometer strips, and lancets, and resident medications in the second drawer, including Eliquis, metoprolol, methocarbamol, and furosemide. At 7:58 AM, the CMA and LPN returned to the cart and the LPN locked it. When asked, both staff members stated the cart had been left unlocked; the CMA said she thought she had locked it, and the LPN said she did not notice it was unlocked until they returned. The Pharmacy Consultant, who was standing about 2 feet away, stated there was not a problem with medication labeling but there was a problem with storage because she witnessed the unlocked cart. Facility policy stated that medication rooms, carts, and medication supplies are to be locked when not attended by persons with authorized access, and the DON and Administrator both stated they expected nurses and medication aides to keep medication carts locked when out of sight.
Call Light Accessibility Deficiency
Penalty
Summary
The facility failed to ensure that a call light was within reach for a resident, leading to a deficiency. Resident #20, who has chronic respiratory failure with hypercapnia and moderate cognitive impairment, was observed without access to their call light. The resident's care plan, revised on 10/17/24, specified that the call light should be within reach and encouraged its use. On 11/06/24, the resident called out to a surveyor for assistance because the call light was placed on a recliner, out of reach, while the resident was seated in a wheelchair. The resident expressed that they could not call for help and needed ice water. CNA #4 confirmed that the facility's policy required the call light to be within reach and acknowledged that it was not in reach upon observation. CNA #4 then pinned the call light to the resident's blanket and provided the requested ice water.
Inaccurate MDS Coding for Dialysis Treatment
Penalty
Summary
The facility failed to ensure an accurate Minimum Data Set (MDS) assessment for a resident diagnosed with end-stage renal disease. The resident's care plan, dated July 11, 2024, indicated that they received dialysis at a local facility three times a week. However, during a quarterly assessment conducted on October 1, 2024, the MDS did not reflect that the resident was receiving dialysis. On November 7, 2024, the MDS Coordinator confirmed that the MDS should have been coded to indicate the resident's dialysis treatment, acknowledging the inaccuracy in the assessment.
Expired Medication Not Removed from Circulation
Penalty
Summary
The facility failed to ensure that expired medications were removed from circulation in the medication storage room, as observed during a survey. The facility's policy required that medications and biologicals be stored safely and securely, following the manufacturer's recommendations, and that outdated medications be immediately removed from inventory. However, during an observation with the Director of Nursing (DON) present, a card of pill-packed Zoloft 100 mg, labeled for a resident with recurrent depressive disorders, was found to be expired. The fill date and expiration date indicated that the medication was no longer valid for use. The DON and Assistant Director of Nursing (ADON) acknowledged that the medication aides were responsible for rotating the medication stock using a first-in, first-out process. They also stated that expired medications should be pulled and placed with discontinued medications. Despite these procedures, the expired Zoloft was still present in the medication storage room, indicating a lapse in the facility's medication management practices.
Failure to Adhere to Enhanced Barrier Precautions
Penalty
Summary
The facility failed to adhere to enhanced barrier precautions for a resident who was on such precautions due to a risk of infection related to a PEG tube and an in-house MDRO. The resident's care plan, revised in September 2024, documented the need for enhanced barrier precautions, including the use of gowns and gloves during high-contact activities such as PEG tube care. However, during an observation in November 2024, an LPN was seen performing PEG tube care for the resident without wearing a gown, despite the presence of an EBP sign on the door and gowns available in the room. The LPN, upon being questioned, stated that they believed the EBP sign indicated the need for handwashing only and did not notice the gowns in the room. They also expressed the belief that wearing a gown was not necessary during PEG tube care. The Director of Nursing later confirmed that enhanced barrier precautions required the use of both a gown and gloves during such care, indicating a lapse in adherence to the facility's infection prevention and control program.
Failure to Maintain Clean Environment for Resident
Penalty
Summary
The facility failed to maintain a clean, comfortable, and homelike environment for a resident, as evidenced by the presence of moderate dust buildup on the ceiling vent in the resident's room. The facility's housekeeping policy, revised in 2012, requires that resident rooms be cleaned from the ceiling down, with ceiling vents specifically mentioned as areas to be dry dusted. Despite this policy, observations on two separate occasions revealed that the ceiling vent in the room of a cognitively intact resident had not been cleaned. The resident confirmed that they had not cleaned the vent themselves. A housekeeper admitted to not paying attention to the ceiling vents during cleaning procedures and acknowledged the need for the vent to be cleaned upon observation.
Missed Care Plan Meeting Due to Staff Turnover
Penalty
Summary
The facility failed to hold a care plan meeting for a resident diagnosed with unspecified dementia and requiring assistance with personal care. The care plan meeting was initially scheduled but not conducted, and the resident's representative was not informed of the cancellation or rescheduling. The facility's administrator indicated that the social worker, who was responsible for organizing care plan meetings, had recently left their position, which contributed to the oversight. The last care plan meeting for the resident was held several months prior, and the facility did not communicate the missed meeting to the family or provide information on rescheduling.
Delayed Urinalysis Specimen Collection
Penalty
Summary
The facility failed to ensure a urinalysis specimen was obtained in a timely manner for a resident diagnosed with unspecified dementia and a UTI. A physician's telephone order on 10/15/24 requested several lab tests, including a urinalysis, due to the resident's generalized weakness. A urine specimen was collected on 10/16/24, but it was not sent to the lab and remained in the ice box. On 10/25/24, after the resident's family inquired about the urinalysis, an LPN discovered the oversight and obtained a new urine specimen, which was then sent to the lab. The DON confirmed that staff are responsible for notifying the lab to pick up specimens promptly and that specimens should be obtained as soon as possible.
Failure to Timely Report Abnormal Lab Results
Penalty
Summary
The facility failed to report an abnormal urinalysis result to the provider in a timely manner for a resident diagnosed with unspecified dementia and a urinary tract infection (UTI). A physician's telephone order was made for several lab tests, including a urinalysis, due to the resident's generalized weakness. The urine specimen was collected and reported positive for a UTI, but there was no documentation that the provider was notified of this abnormal result on the date it was reported. The delay in notification is evident as the physician order for an antibiotic was not documented until several days later. Interviews with facility staff, including an LPN and the Director of Nursing (DON), confirmed that the provider was not notified promptly. Additionally, the facility lacked a lab policy to guide staff on the notification process for abnormal lab results, as confirmed by a corporate nurse consultant.
Failure to Follow Up on Dental Referral
Penalty
Summary
The facility failed to follow up on a physician-ordered dental referral for a resident who required a new upper denture plate. The resident, who had chronic obstructive pulmonary disease and wore upper dentures, was documented to have broken or loosely fitting dentures. Despite a physician's order for a dental referral, the resident had not seen a dentist. The resident reported losing their dentures about a month prior and informed their physician, who issued an order for a dental referral. However, the order was not acted upon. Interviews revealed that the LPN was aware of the order and had passed it to the social services worker, but the resident had not been scheduled to see a dentist. The activities director, who assisted with social service duties, was unaware of the need for a dental appointment, as the previous social service worker had not acted on the order.
Lack of Privacy Curtain for Resident
Penalty
Summary
The facility failed to ensure privacy for a resident by not providing a privacy curtain in one of the sampled resident rooms. Resident #55, who has a diagnosis of diabetes mellitus type two and intact cognition, was observed sitting on their bed without a privacy curtain available to pull across the room. The resident expressed a desire for a privacy curtain to maintain privacy. An LPN confirmed that curtains should be closed to provide privacy but acknowledged that Resident #55's room lacked such a curtain, despite the resident's expressed need for one.
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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 Oklahoma City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| South Pointe Rehabilitation And Care Center | 0.3 mi | ★★★★★ | 0 | 0 |
| Emerald Care Center Southwest Llc | 1.9 mi | ★★★★★ | 1 | 0 |
| Brookwood Skilled Nursing And Therapy | 2.4 mi | ★★★★★ | 1 | 0 |
| South Park East | 2.5 mi | ★★★★★ | 10 | 0 |
| Accel At Crystal Park | 2.6 mi | ★★★★★ | 10 | 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 August 2026) and official state health department websites.