Below average — CMS composite of the measures below.
The next survey window likely opens around August 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Drumright Nursing Home during CMS and state inspections, most recent first.
A resident with dementia repeatedly physically assaulted other cognitively impaired residents, including slapping and hitting, sometimes causing injuries. Staff did not consistently notify law enforcement or families, failed to update care plans, and did not provide post-incident education or conduct safety assessments, contrary to facility policy.
A resident with severe malnutrition and dependence for transfers slid out of a wheelchair during van transport and sustained a leg laceration requiring sutures; the transport van lacked a working wheelchair seatbelt, and the transporter was not educated on securing the resident. Another resident with dementia and high fall risk had multiple falls, including one with a skin tear and one with a head strike, but there was no documentation that fall interventions were initiated after those incidents.
PRN psychotropic meds were not limited to 14 days for two residents. One resident with dementia and anxiety had a PRN lorazepam order with no stop date and repeated MAR administrations beyond the limit, while another resident with impaired cognition and multiple behavioral diagnoses had PRN Ativan and ABH gel orders set for 60 days. Staff stated the meds required reassessment after 14 days, but the orders continued past the regulatory timeframe.
A resident's discharge assessment was not transmitted to the State within the required timeframe. The record showed a planned discharge and no documentation that the completed assessment was sent. The ADON stated the RN was responsible for transmitting assessments, and the IP stated assessments were usually tried within five days of completion, but confirmed this resident's discharge assessment was not transmitted.
Nebulizer Equipment Not Stored Properly: A resident receiving scheduled breathing treatments had a nebulizer mask observed on the nightstand and tubing on the floor by the bed. The resident had severely impaired cognition and COPD, and an LPN stated the mask was cleaned and left on a paper towel or sink to air dry until the next treatment rather than being stored in a labeled plastic container or covering as described in the facility policy.
A resident with severe cognitive impairment and a history of exit-seeking behaviors repeatedly eloped from the facility, including being found walking near a highway, due to inadequate supervision and lack of timely care plan updates. Staff were aware of the resident's risk but did not consistently implement or document increased monitoring, and several staff reported not receiving specific training on elopement prevention. Facility doors could be bypassed, and there was no specific elopement policy in place.
A resident with severe cognitive impairment and a history of elopement was not consistently care planned for each incident of leaving the facility unsupervised. Despite multiple episodes of elopement, the care plan was either delayed or not updated to reflect these events, contrary to facility policy and assessment requirements.
The facility failed to conduct thorough investigations after abuse allegations involving two residents. One resident, with intact cognition, reported fear of a CNA, but the investigation lacked interviews and external notifications. Another resident, with moderately impaired cognition, complained about a CNA's actions, but the investigation did not notify adult protective services or the nurse aide registry. The DON confirmed the investigations were incomplete.
The facility failed to ensure proper treatment and monitoring of pressure ulcers for two residents, resulting in the worsening of their conditions. Despite physician orders for daily wound care, there was no documentation of wound care being performed on multiple occasions, leading to the deterioration of the wounds. Observations confirmed that wound care was not consistently provided, and the wounds worsened over time. Additionally, there was a lack of documentation for repositioning the residents every two hours as per physician orders, contributing to the worsening of the pressure ulcers.
The facility failed to ensure their social worker met the required qualifications for a facility licensed for 133 beds. The social worker had an associate in arts and six years of experience as a case manager at a prison, but did not have the required bachelor's degree. This was confirmed by the ADON and DON during an interview.
A resident with anxiety and agitation received Ativan beyond the 14-day limit specified in the physician's order. The medication was administered in February and March 2024, and the ADON and DON acknowledged that the order should have been stopped and reassessed.
The facility failed to maintain an infection control program for two residents with pressure ulcers. An LPN did not clean a metal pan after it came into contact with a resident's personal belongings and bedside table, and another LPN did not clean the bedside table or the metal pan after wound care. These actions were against the facility's infection control policy.
The facility failed to ensure food was served at an appetizing temperature, with multiple residents reporting that their meals were often cold and unappetizing. A food test tray confirmed the issue, with breaded squash served at 108 degrees Fahrenheit.
The facility failed to maintain sanitary food preparation and serving practices. A dietary aide did not wash their hands when entering the kitchen multiple times, and a dietary cook used hand sanitizer instead of washing hands with soap and water while serving food. The dietary manager was unaware that hand sanitizer could not be used in the kitchen.
The facility failed to ensure a resident's code status was accurate. A resident with heart disease, COPD, a pacemaker, chronic pain, and CKD had a DNR consent form, but a physician order documented CPR. The ADON and DON confirmed the resident was supposed to be a DNR, indicating a discrepancy.
The facility failed to provide a resident with the required SNF ABN and/or NOMNC notices upon discharge from Part A skilled services, despite having benefit days remaining. The resident, who had multiple diagnoses including COPD and heart failure, was hospitalized, and there was no documentation that the necessary notices were given to the resident or their legal representative.
The facility failed to ensure a discharged resident's clinical record contained a discharge summary. The resident had multiple diagnoses, including COPD and heart failure. A physician order documented the resident was discharged home, but no discharge summary was completed. The ADON confirmed the summary was not completed within the required timeframe.
A resident with multiple diagnoses was discharged home without a written 30-day notice. The ADON confirmed that only a verbal notice was given by the administrator, despite the resident's Medicaid case still pending.
The facility failed to allow a resident to return after hospitalization, despite having a bed-hold policy of five days. The resident, with multiple diagnoses, was hospitalized due to a drop in oxygen saturation. The family was incorrectly informed that the resident had no skilled service days remaining, and the resident was not permitted to return.
The facility failed to refer a resident with newly diagnosed serious mental illnesses, including bipolar type schizophrenia disorder and borderline personality disorder, to the OHCA for a level II PASRR evaluation, despite the initial level I PASRR indicating no serious mental illness.
The facility failed to include a care plan regarding dietary preferences for a resident diagnosed with vitamin D deficiency and depression. A physician order specified a no added salt vegetarian diet and smoothies with super greens powder, but the ADON acknowledged that these preferences were not included in the care plan.
The facility failed to verify CNA certification for two CNAs, allowing them to work with expired certifications. The ADON indicated that the IP nurse was responsible for this task, but the IP nurse was unavailable for an interview.
The facility failed to ensure the QAA committee met at least quarterly. There was no documentation of meetings from October 2023 through December 2023. The DON confirmed the lack of documentation despite the requirement for quarterly meetings.
The facility failed to offer an influenza vaccine to a resident admitted after a vaccination clinic held at the end of 2023. The resident's vaccination record showed they had not received the vaccine, and the IP confirmed that new admissions were not offered vaccinations post-clinic.
The facility failed to follow the dietitian-approved menu for a meal service, substituting meatloaf for pork chops and devil cake for chocolate cream dessert without notifying the dietitian. This affected 52 residents, including two who rely solely on feeding tubes.
Failure to Protect Residents from Physical Abuse and Inadequate Incident Response
Penalty
Summary
The facility failed to protect residents from physical abuse, specifically involving multiple incidents where one resident with dementia and Alzheimer's disease physically assaulted other residents. The resident in question exhibited repeated aggressive behaviors, including slapping, hitting, and using objects to strike other residents, all of whom had varying degrees of cognitive impairment. Incident reports documented several episodes where this resident slapped or hit others, sometimes causing visible injuries such as a knot on the head or facial soreness. Despite these occurrences, there was no evidence that staff provided education following the incidents, nor were law enforcement or the residents' families consistently notified as required by policy. Care plans for the involved residents were not consistently updated to reflect the incidents or to implement new interventions to prevent further abuse. For example, after a resident was slapped and sustained a head injury, their care plan was not revised to address the new risk. Similarly, other residents who were assaulted did not have their care plans updated to include additional safety measures or interventions. Staff interviews revealed a lack of awareness and documentation regarding post-incident education, law enforcement notification, and the completion of safe surveys to assess and ensure resident safety after each event. The facility's own policy required screening, training, prevention, identification, investigation, protection, and reporting of abuse, but these steps were not followed in practice. Staff and administration admitted to not contacting law enforcement for incidents they deemed minor, such as slapping, and did not conduct safe surveys or provide education after the altercations. There was also no evidence of quality assurance reviews or new interventions being established following the incidents. The repeated failure to follow established protocols and update care plans left residents vulnerable to further abuse.
Removal Plan
- Resident #28 has been referred for inpatient geri-psych services.
- Resident #28 was immediately placed on one-on-one supervision until departure from the facility.
- All staff will receive inservice training regarding abuse prevention including resident to resident abuse.
- Staff will receive training to intervene when resident to resident abuse occurs, report abuse immediately to the Administrator, assess or evaluate the resident who sustained abuse for injury, and document those findings in the resident record.
- An intervention(s) will be established for each episode of resident-to-resident abuse at the time of the occurrence, communicated to staff, and updated to the resident's care plan.
- An intervention communication form will be used to communicate to staff all new occurrences and interventions.
- All staff received inservice either in person or by phone call. For any staff member that could not receive inservice in person or by phone, they will be required to receive inservice before their next scheduled shift.
- Inservice education will be provided by the DON, RN, and Care Plan Coordinator.
- Resident #28 had no access to any other resident outside of the memory care unit.
- All residents on the memory care unit were safe from abuse immediately when one on one supervision was established for resident #28.
- Resident #28 was transferred via EMSA from the building for geri-psych services.
- Each resident on the memory care unit will receive a head to toe assessment for injury and will be asked about their safety.
- The Plan of Removal will be completed.
Failure to Secure Resident During Transport and Lack of Fall Interventions
Penalty
Summary
The facility failed to prevent a fall during transportation for Resident #2. The resident’s admission assessment showed diagnoses including severe protein-calorie malnutrition and adult failure to thrive, with intact cognition and dependence on staff for activities of daily living and transfers. During transport to a doctor’s appointment, the resident slid out of a wheelchair in the van and sustained a laceration to the right lower leg, requiring emergency care and sutures. The incident investigation showed the transport van did not have a working seatbelt for wheelchair transport, and the transporter stated they were not aware the resident needed to be secured and had not been educated on what was needed for resident transportation. The facility also failed to ensure interventions were initiated after repeated falls for Resident #9. Three fall incidents were documented: the resident was found lying on the floor near the foot of the bed with no injury; later, the resident tried to get out of a wheelchair unassisted, slid to the buttock, and sustained a skin tear above the right elbow while not wearing nonskid socks; and later, the resident was found sitting on the floor after stating they scooted down onto the floor from the edge of the bed and hit their head. Neurological checks were started after the head injury, and the resident was placed on one-on-one until sleepy. Record review showed no documentation that interventions were implemented after any of the three falls to prevent future falls or injury. The resident’s later assessment showed severely impaired cognition with a BIMS of 03, and the care plan identified the resident as high risk for falls related to confusion, gait and balance problems, and being unaware of safety needs. Staff stated fall interventions were based on the root cause of the fall, and the ADON stated there were no fall interventions for the above dates.
PRN Psychotropic Medications Exceeded 14-Day Limit
Penalty
Summary
The facility failed to ensure PRN psychotropic medications were limited to 14 days for two residents reviewed for unnecessary medication. The facility policy stated PRN psychotropic drugs are limited to 14 days unless the physician documents a rationale for extending the order and indicates the duration in the resident’s medical record. For one resident with dementia and anxiety, a lorazepam PRN order dated 07/25/25 had no stop date, and the MAR showed repeated administrations beyond the 14-day limit in August and September. The DON stated the order had no stop date and that the pharmacist consult showed the physician needed to evaluate the PRN use, but the physician’s response provided no rationale for continuing the medication. For the second resident, who had moderately impaired cognition and diagnoses including disruptive mood dysregulation disorder, anxiety disorder, mild cognitive impairment, disorientation, manic episode, and behavioral disturbance related to Alzheimer’s and dementia, the record showed PRN psychotropic orders for topical Ativan and ABH gel with stop dates set for 60 days. The Ativan order dated 08/27/25 and the ABH gel order dated 09/08/25 were both administered within the resident’s MARs, and staff stated the orders exceeded the 14-day requirement. An LPN stated the medications were to be reassessed after 14 days, but the orders defaulted to 60 days and did not meet the regulatory standard for PRN psychotropic use.
Failure to Transmit Discharge Assessment
Penalty
Summary
The facility failed to ensure that a resident's discharge assessment was transmitted to the State within the required timeframe for 1 of 12 sampled residents. Resident #24 had a discharge assessment marked return not anticipated, dated 05/31/25, and the record showed the resident had a planned discharge on [DATE]. There was no documentation that the discharge resident assessment was transmitted. During interviews on 09/22/25, the ADON stated the registered nurse was responsible for transmitting completed resident assessments, the IP stated assessments were tried to be transmitted within five days of completion, and the IP later stated that Resident #24's discharge assessment dated [DATE] was not transmitted.
Nebulizer Equipment Not Stored Properly
Penalty
Summary
The facility failed to ensure a nebulizer mask and tubing were stored in a manner to prevent cross contamination for Resident #58. On 09/15/25 at 12:42 p.m. and again on 09/22/25 at 10:46 a.m., a nebulizer mask was observed laying on the resident’s nightstand, and on 09/22/25 the part of the tubing that connected to the machine was observed laying on the floor by the resident’s bed. The facility policy stated that when the equipment is not in use, it may be stored in a plastic container or covering. Resident #58 had a physician’s order dated 09/08/25 for ipratropium-albuterol inhalation solution, 3 mg/3 ml, to inhale one vial orally four times a day for wheezing. The resident’s admission assessment dated 09/12/25 showed severely impaired cognition with a BIMS of 06. The care plan dated 09/15/25 identified a diagnosis of unspecified chronic obstructive pulmonary disease and noted the resident received breathing treatments. On 09/22/25, an LPN stated that after nebulizer treatment, the mask would be cleaned, set on a paper towel, and left on the sink to air dry in the resident’s room until the next treatment, and acknowledged that the mask and tubing were not stored appropriately. The DON stated the nebulizer mask should be cleaned with soap and water, air dried, and stored in a plastic container or covering when not in use, labeled with the resident’s name.
Failure to Prevent Elopement and Provide Adequate Supervision for Cognitively Impaired Resident
Penalty
Summary
A deficiency occurred when the facility failed to provide adequate supervision and prevent accidents for a resident with severe cognitive impairment and a known history of exit-seeking behaviors. The resident, diagnosed with Alzheimer's disease, non-Alzheimer's dementia, and a psychotic disorder, had a BIMS score indicating severe cognitive impairment and was assessed as high risk for wandering. Despite multiple documented incidents of the resident attempting to exit or successfully eloping from the facility, the care plan addressing elopement risk was not created until after the first elopement and was not updated following subsequent incidents. The resident was able to leave the facility on several occasions, including escaping through the front door and being found walking down a nearby highway and in the facility lawn. Staff interviews and documentation revealed that doors could be opened by holding them for a period of time, and staff were aware of the resident's risk but did not consistently implement or document increased supervision or interventions. There were also gaps in the documentation of required 15-minute checks following elopement incidents, and staff reported not receiving specific training related to elopement prevention or response. Other residents and staff confirmed that multiple residents exhibited wandering or exit-seeking behaviors, and that the facility's doors, while coded, could be bypassed. The facility lacked a specific elopement policy, relying instead on a missing persons policy, and staff responses to elopement incidents were inconsistent. The infection control nurse identified several residents at risk for elopement, but there was no evidence of systematic involvement of the facility's QAPI process in addressing these incidents.
Failure to Update Care Plan After Resident Elopements
Penalty
Summary
The facility failed to ensure that a resident's care plan was updated to reflect each incident of elopement. A resident with severe cognitive impairment, including diagnoses of Alzheimer's disease, non-Alzheimer's dementia, and psychotic disorder, was identified as being at risk for elopement. Despite multiple documented incidents where the resident left the facility unsupervised, the care plan was not updated after each event. The initial care plan addressing elopement risk was not created until two days after the first documented elopement, and subsequent elopements were not reflected in the care plan at all. Record review and staff interviews confirmed that the care plan did not document the actual elopement events, nor was it revised following additional incidents. The facility's policy required the interdisciplinary team to review and update the comprehensive care plan after each assessment, but this was not followed in practice. Staff responsible for updating care plans were either unavailable or assumed updates had been made, and the Director of Nursing confirmed that no updates were found in the care plan after the resident's repeated elopements.
Incomplete Abuse Investigations for Two Residents
Penalty
Summary
The facility failed to conduct thorough investigations following allegations of abuse involving two residents. For the first resident, who had intact cognition, an incident report was filed after the resident expressed fear of a CNA being rough and rushing them. However, the investigation lacked interviews with other residents or staff, and there was no evidence of specific abuse found. Additionally, adult protective services were not notified of the allegation. For the second resident, who had moderately impaired cognition, an incident occurred where the resident did not want to be checked by a CNA, leading to a complaint. The investigation did not include notification to adult protective services or the nurse aide registry. The Director of Nursing confirmed that the investigations were incomplete, as they did not involve interviews with other residents or external notifications, contrary to the facility's policy.
Failure to Provide Proper Pressure Ulcer Care
Penalty
Summary
The facility failed to ensure proper treatment and monitoring of pressure ulcers for two residents, resulting in the worsening of their conditions. Resident #49, who had peripheral vascular disease and a right lower leg amputation, developed a stage II pressure ulcer on the left heel. Despite physician orders for daily wound care, there was no documentation of wound care being performed on multiple occasions, leading to the deterioration of the wound to a stage I ulcer with significant necrosis. Observations confirmed that the wound care was not consistently provided, and the wound worsened over time, as noted by the Director of Nursing (DON) and Assistant Director of Nursing (ADON). The resident also declined hospital transfer despite significant changes in the wound condition, further complicating the situation. Additionally, there was a lack of documentation for repositioning the resident every two hours as per physician orders, contributing to the worsening of the pressure ulcer. Resident #51, who had type 2 diabetes mellitus and other conditions, was admitted with a stage II pressure ulcer on the coccyx and later developed a stage I pressure ulcer on the right heel. The facility's records showed inconsistent documentation and treatment of the wounds. The resident's condition worsened, with the coccyx wound increasing in size and a new pressure ulcer developing below the existing one. Observations and interviews revealed that wound care was not consistently performed, and there was no documentation of treatment orders or assessments for the new wound. The ADON confirmed the lack of documentation and treatment for the resident's pressure ulcers, indicating a failure to follow the facility's policy and procedure for pressure ulcer prevention and treatment.
Unqualified Social Worker in Facility with Over 120 Beds
Penalty
Summary
The facility failed to ensure the individual functioning as the social worker met the required qualifications for a facility with more than 120 beds. The facility was licensed for a maximum of 133 beds, but the social worker employed only had an associate in arts and six years of experience as a case manager at a prison, lacking the required bachelor's degree. This was confirmed by the Assistant Director of Nursing (ADON) and Director of Nursing (DON) during an interview, where they acknowledged the social worker's qualifications did not meet the necessary standards for the facility's size.
Failure to Limit PRN Psychotropic Medication to 14 Days
Penalty
Summary
The facility failed to ensure a PRN psychotropic medication was limited to 14 days for one of five sampled residents reviewed for unnecessary medications. The resident had diagnoses including anxiety and agitation and had a physician order for Ativan suspension, to be given sublingually every four hours as needed for 14 days. However, the medication was administered beyond the 14-day limit, as documented in the February and March 2024 Medication Administration Records (MAR). The Assistant Director of Nursing (ADON) and Director of Nursing (DON) acknowledged that the order should have been stopped and reassessed.
Infection Control Deficiency in Wound Care
Penalty
Summary
The facility failed to maintain an infection control program to help prevent the transmission of infections for two residents reviewed for pressure ulcers. Resident #2, who had diagnoses including severe sepsis and a need for assistance with personal care, had a physician order to cleanse the area on the inner left foot with Betadine and cover it with a protective dressing daily. An LPN was observed performing wound care for this resident but failed to clean the metal pan used during the procedure after it came into contact with the resident's personal belongings and bedside table. The LPN placed the uncleaned metal pan back into the treatment cart with other supplies, which was against the facility's wound dressings policy that required cleaning or discarding anything brought into the room after use. Resident #51, who had diagnoses including type 2 diabetes mellitus and pressure ulcers, was also subject to improper infection control practices. An LPN performed wound care for this resident without cleaning the bedside table or providing a clean barrier before placing the metal pan on it. After completing the wound care, the LPN placed the metal pan on the resident's bed and then on the treatment cart without cleaning it. This action was contrary to the facility's infection control policy, which required cleaning the metal pan after it touched the resident's personal belongings. Both instances demonstrated a failure to adhere to the facility's infection control protocols, potentially increasing the risk of infection transmission.
Failure to Serve Food at Appetizing Temperature
Penalty
Summary
The facility failed to ensure that food was served at an appetizing temperature and was palatable for the residents. Multiple residents reported that the food was often cold and unappetizing. Resident #5, with intact cognition, stated that the food was sometimes cold when eaten in their room. Resident #7, who was moderately impaired in cognition, mentioned that the food was cold all the time and sometimes excessively salty, making it inedible. Resident #14, with intact cognition, also reported receiving cold food when eating in their room. Similar complaints were echoed by Resident #22, Resident #30, and Resident #40, all of whom had intact cognition and reported that their food was always cold or not good. Resident #155, with intact cognition, also stated that the food was not good. On a specific date, a food test tray was received from the kitchen, and the breaded squash served was found to be lukewarm and flavorless, with a temperature of 108 degrees Fahrenheit. This observation confirmed the residents' complaints about the food being served at an inappropriate temperature. The facility's failure to maintain the food at a safe and appetizing temperature led to dissatisfaction among the residents, impacting their overall dining experience and nutrition intake.
Failure to Maintain Sanitary Food Preparation and Serving Practices
Penalty
Summary
The facility failed to prepare and serve food in a sanitary manner. Dietary aide #1 was observed preparing drinks for the lunch meal without washing their hands when entering the kitchen multiple times. They handled various items, including a container of coffee and a gallon of milk, without proper hand hygiene. This lack of handwashing occurred despite moving between the dining room and the kitchen several times during meal preparation. Additionally, dietary cook #2 was observed serving the lunch meal and using an alcohol-based hand sanitizer instead of washing their hands with soap and water. The cook wiped their nose and sweat from their forehead, used the hand sanitizer, and continued serving food without proper handwashing. The dietary manager (DM) admitted to not knowing that hand sanitizer could not be used in the kitchen and confirmed that everyone entering the kitchen should wash their hands with soap and water.
Discrepancy in Resident's Code Status
Penalty
Summary
The facility failed to ensure a resident's code status was accurate. A resident with diagnoses including heart disease, COPD, presence of a pacemaker, chronic pain, and CKD had a DNR consent form dated [DATE], indicating the resident's consent for DNR. However, a physician order dated [DATE] documented CPR for the same resident. When asked to verify the resident's code status, the ADON and DON confirmed that the resident was supposed to be a DNR, indicating a discrepancy between the documented DNR consent and the physician's order for CPR.
Failure to Provide Required Beneficiary Notices
Penalty
Summary
The facility failed to ensure that a resident discharged from Part A skilled services, with benefit days remaining, was issued a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) and/or Notice of Medicare Non-Coverage (NOMNC). The deficiency was identified for one of four sampled residents reviewed for beneficiary notices. The Beneficiary Notice worksheet indicated that eight residents were discharged from Part A skilled services with benefit days remaining in the past six months. Specifically, the resident was admitted to the facility for skilled services with multiple diagnoses, including COPD, heart failure, CKD, type 2 diabetes mellitus, amputation of toes, and a history of falling. On a particular date, the resident's health deteriorated, leading to hospitalization, and there was no documentation that the required beneficiary notices were provided to the resident or their legal representative. The Assistant Director of Nursing (ADON) and Director of Nursing (DON) were questioned about the resident's last day of skilled service and the provision of beneficiary notice forms. The ADON confirmed that the resident had five days of skilled service left when they were sent to the hospital and acknowledged that the resident's family member was incorrectly informed about the remaining skilled service days. The ADON also stated that the resident should have been provided with the beneficiary notice forms upon their return to the facility and that a two-day notice was required. However, there was no documentation to support that these notices were given, leading to the identified deficiency.
Failure to Complete Discharge Summary
Penalty
Summary
The facility failed to ensure a discharged resident's clinical record contained a discharge summary. The resident had diagnoses including COPD, heart failure, type 2 diabetes mellitus, panic disorder, and major depressive disorder. A physician order documented the resident was discharged home, but there was no documentation of a discharge summary being completed. When asked, the Assistant Director of Nursing (ADON) stated they had 30 days to complete a discharge summary, but it was not completed within that timeframe.
Failure to Provide Written Discharge Notice
Penalty
Summary
The facility failed to notify a resident and/or their representative in writing 30 days before the resident was discharged. The resident, who had diagnoses including COPD, heart failure, type 2 diabetes mellitus, panic disorder, and major depressive disorder, was admitted to the facility and later denied nursing home Medicaid due to not sending in verification. Despite the resident's case still pending with DHS, the resident was discharged home without a written notice. The ADON confirmed that no written notice was provided, and only a verbal 30-day notice was given by the administrator.
Failure to Permit Resident's Return After Hospitalization
Penalty
Summary
The facility failed to ensure a resident was permitted to return after hospitalization, violating their bed-hold policy. The resident, who had multiple diagnoses including COPD, heart failure, CKD, type 2 diabetes mellitus, amputation of toes, and a history of falling, was admitted to the facility for skilled services. On 04/01/24, the resident's oxygen saturation dropped, and despite a breathing treatment, their condition did not improve, leading to hospitalization. The facility's bed-hold policy allowed for a five-day hold, but the resident was not permitted to return after hospitalization, and the family was informed that the resident had no skilled service days remaining, which was incorrect according to the ADON's statement. A social service note dated 04/02/24 documented that the resident's family was informed that the resident was in the hospital past their discharge date from skilled nursing services and that it would be up to the family and the hospital to arrange transportation home. The ADON confirmed that the resident had five days of skilled service left when they went to the hospital and did not know why the family was informed otherwise. The resident had no payer source after the skilled days, which contributed to the facility's decision not to permit the resident's return.
Failure to Refer Resident for Level II PASRR Evaluation
Penalty
Summary
The facility failed to refer a resident with a newly evident or possible serious mental illness to the OHCA for a level II PASRR evaluation. Initially, a level I PASRR dated 06/27/23 documented that the resident did not have evidence or diagnosis of a serious mental illness. However, on 07/28/23, the resident received a new diagnosis of bipolar type schizophrenia disorder, and on 07/29/23, the resident was further diagnosed with borderline personality disorder and mood disorder due to a known physiological condition with depressive features. Despite these new diagnoses, there was no documentation that the resident had been referred to the OHCA for a level II PASRR evaluation. On 05/08/24, the ADON and DON were informed of the oversight and confirmed that the resident had not been referred for the necessary evaluation.
Failure to Include Dietary Preferences in Care Plan
Penalty
Summary
The facility failed to include a care plan regarding dietary preferences for a resident diagnosed with vitamin D deficiency and depression. A physician order dated 04/01/24 specified that the resident required a no added salt vegetarian diet and smoothies with super greens powder as a supplement. However, during an interview on 05/07/24 at 9:24 a.m., the Assistant Director of Nursing (ADON) acknowledged that the resident's food preferences were not included in the care plan, as they should have been. This oversight was identified during a review of the resident's records.
Failure to Verify CNA Certification
Penalty
Summary
The facility failed to ensure verification from the nurse aide registry before allowing two CNAs to work. CNA #4's certification expired, yet they continued to work on multiple dates as documented in the Time & Attendance - Employee Timecard. Similarly, CNA #5's certification also expired, and they were documented to have worked on several dates. The ADON stated that the IP nurse was responsible for ensuring staff had current licenses and certifications, but the IP nurse was unavailable for an interview.
Failure to Ensure Quarterly QAA Committee Meetings
Penalty
Summary
The facility failed to ensure the Quality Assessment and Assurance (QAA) committee met at least quarterly. The administrator identified that 54 residents resided in the facility. There was no documentation that the QAA committee met from October 2023 through December 2023. On May 7, 2023, at 9:33 a.m., the Director of Nursing (DON) was asked to provide documentation of the QAA committee meetings for the specified quarter. At 10:37 a.m., the DON stated there was no documentation of the QAA committee meeting during that period, despite the committee being required to meet quarterly.
Failure to Offer Influenza Vaccine to New Resident
Penalty
Summary
The facility failed to offer an influenza vaccine to a resident who was admitted after a vaccination clinic held at the end of 2023. The resident's vaccination record showed that they had not received the influenza vaccine. The Infection Preventionist (IP) confirmed that vaccinations were not offered to residents admitted after the clinic.
Failure to Follow Approved Menu
Penalty
Summary
The facility failed to follow the menu approved by the facility's dietitian for one meal service observed. Specifically, the lunch menu for 05/07/24 was supposed to include pork chop, broccoli rice casserole, breaded squash, a dinner roll, chocolate cream dessert, and a beverage of choice. However, due to a shortage of pork chops, the menu was changed to meatloaf without notifying the facility dietitian. Additionally, the chocolate cream dessert was replaced with devil cake. This change affected 52 residents who received services from the kitchen, with two residents receiving nutrition and hydration solely through a feeding tube. The dietary manager (DM) confirmed that the administrator made changes as needed without consulting the dietitian.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 11 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Drumright
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Linwood Village Nursing & Retirement Apts | 8.1 mi | ★★★★★ | 0 | 0 |
| Rainbow Health Care Community And Rainbow Assisted | 16.7 mi | ★★★★★ | 6 | 0 |
| Stroud Nursing & Rehab | 17 mi | ★★★★★ | 0 | 0 |
| Cimarron Pointe Care Center | 18 mi | ★★★★★ | 0 | 0 |
| Cleveland Care And Rehab Center | 23.7 mi | ★★★★★ | 5 | 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 June 2026) and official state health department websites.