Below average — CMS composite of the measures below.
The next survey window likely opens around March 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 Memorial Heights Nursing Center during CMS and state inspections, most recent first.
Failure to Monitor and Document Food Temps: The dietary manager was observed preparing puree roast, peas, and rice pilaf and placing the roast on the steam table without first checking final cooking temps. The temp was taken only after the food was already on the steam table, and the temp log was largely blank for multiple meal services. The dietary manager and cook could not explain how proper cooking temps were ensured.
Missing dialysis assessments and weights: A resident with renal failure who received hemodialysis had no documented before and after dialysis assessments or weights for multiple scheduled treatments. An LPN stated assessments were completed and paperwork was sent with the resident to the dialysis center, but the documentation could not be located, and the weights were not appearing correctly in the EMR due to an incorrectly entered order.
Failure to notify resident representatives of significant changes in condition. Two residents had major events, including CPR with EMS transfer and a fall with injuries and hospital transfer, but the facility had no documentation that family or next of kin were notified at the time. The DON stated staff were to notify the physician and family, but the family for one resident was not reached until later when they came to the facility.
Failure to provide and document catheter care for a resident with an indwelling urinary catheter. The resident had orders for catheter drainage and monthly catheter changes, a recent UTI, urinary retention, and dependence with toileting, but the EMR had no catheter care order. The resident said staff changed the catheter monthly but did not provide catheter care, while the resident performed their own daily catheter care. An LPN said catheter care was done every shift and should have had an order, and the DON said catheter care should have been documented.
A resident who required 2-person assist for ADLs was observed in bed with the call light on the floor behind the head of the bed and not within reach. A CNA later retrieved the call light, even though the resident was able to use it and staff stated call lights were kept within residents' reach and checked constantly.
A resident with a fractured femur, HTN, and edema was discharged home, but the discharge resident assessment was not completed or transmitted as required. The DON said the MDS coordinator was responsible for MDS assessments, and the administrator later confirmed the discharge assessment had not been completed and that they were responsible for ensuring MDS completion.
A resident with COPD was receiving hospice services, but the care plan did not include hospice interventions. The quarterly assessment documented hospice, and both the DON and administrator confirmed the care plan lacked hospice-related interventions.
Medication refrigerators in the med room contained medications mixed with staff food and drinks. One refrigerator held tuberculin medication with yogurt and soda and water bottles, and another held insulin bottles and pens with an ice cream sandwich and a packaged sandwich. The DON stated the food and drink items belonged to staff and should not have been stored in the medication refrigerators.
A facility failed to notify a physician about a significant change in a resident's wound condition. The resident, with a displaced fracture and heart failure, had a sore that worsened without physician notification. Interviews with LPNs and the administrator confirmed the requirement for immediate reporting of such changes.
A facility failed to implement enhanced barrier precautions for a resident with a stage four pressure ulcer. The policy requires gowns and gloves during high-contact care to prevent the spread of MDROs. An LPN began wound care without a gown and only donned it after starting, while a CNA did not wear a gown at all. The LPN admitted forgetting the gown, and the CNA was unfamiliar with the precautions. Another LPN confirmed the requirement for gowns during such care.
The facility failed to implement its abuse policy for three residents involved in separate incidents of abuse or altercations. Despite notifying some internal staff and authorities, the facility did not report these incidents to the state agency as required by their policy. The administrator acknowledged the oversight, noting that the incidents should have been reported within two hours and thoroughly investigated.
The facility failed to report abuse allegations to the state agency within the required timeframe for three residents involved in separate incidents. Despite the facility's policy requiring immediate reporting, the administrator did not initially consider the incidents as abuse, leading to a lack of timely notification and investigation.
The facility failed to investigate and report abuse allegations involving three residents. One resident with anxiety and depression was slapped by another, but the administrator was not notified, and no state report was filed. Another resident involved in a similar incident had no state report or witness statements documented. A third resident with chronic conditions was pushed, resulting in a fall, but the incident was not reported to the state. The administrator admitted these incidents should have been reported and investigated per policy.
Failure to Monitor and Document Food Temperatures
Penalty
Summary
The facility failed to ensure proper final cooking temperatures were monitored before food was placed on the steam table for holding before meal service, and it also failed to maintain a log documenting final cooking temperatures and holding temperatures for one observed meal service. During observation, the dietary manager was seen preparing puree roast, peas, and rice pilaf, and then placing the roast on the steam table, but there was no observation that temperatures were taken before the food was held. The dietary manager later obtained a temperature of the roast at 209 degrees Fahrenheit after it had already been placed on the steam table. Record review showed the temperature book for April contained only one documented temperature for each meal item for breakfast, lunch, and dinner, and the page was blank for all meals from 04/09/26 through 04/14/26. The dietary manager stated they had breakfast and lunch cooking temperatures written on paper but left the paper at home, and [NAME] #1 stated they were the evening cook and had not done the temperatures. The dietary manager further stated they cooked the food, placed it on the steam table, and then obtained the temperature of the food, and both the dietary manager and cook #1 were unable to state how proper cooking temperatures were ensured.
Missing dialysis assessments and weights
Penalty
Summary
The facility failed to ensure that a resident who required hemodialysis received documented before and after dialysis assessments and weights. Resident #26 had a diagnosis of renal failure and was receiving dialysis while residing in the facility. Physician orders directed that the resident be assessed at the dialysis site every day and night shift, receive hemodialysis every Tuesday, Thursday, and Saturday, and be weighed before and after dialysis on those treatment days. Record review showed no documentation of before and after dialysis assessments for Tuesday 03/31/26, Thursday 04/02/26, or Saturday 04/04/26. There were also no weights located for before and after dialysis. An LPN stated that a head-to-toe assessment was completed before each treatment and that the documentation was on paper and scanned into the EMR, and that a form was sent with the resident to the dialysis center and returned for scanning. The LPN later stated they were unable to locate the before and after dialysis documentation for the dates in question and did not see documentation that the resident refused dialysis. The LPN also stated the before and after weights were in the EMR weights section, but the order had been entered incorrectly and did not show up on the treatment sheet.
Failure to Notify Resident Representatives of Significant Changes in Condition
Penalty
Summary
The facility failed to ensure resident representatives were notified of changes in condition for 2 of 3 sampled residents reviewed for change of condition. The facility’s Notification of Changes policy stated the facility must immediately inform the resident representative(s) when there is a significant change in the resident’s physical, mental, or psychosocial status. For Resident #98, a nursing note documented cardiopulmonary resuscitation was performed and EMS transported the resident to the hospital, but there was no documentation that the resident’s representative was notified of the change in condition or transfer. The resident representative stated they were not notified, and the DON stated staff were to notify the physician and family of a change in condition but could not locate documentation that the family was notified. For Resident #100, a nursing note documented the resident was found seated on the floor in their room with injuries including a large hematoma to the right elbow and right inner forearm, a skin tear to the left inner wrist, and an abrasion to the left knee, and the resident stated they fell while going to the bathroom and hit their head. The note also stated the facility was unable to locate the next of kin contact information at the time of the event. There was no documentation that the next of kin was notified when the resident was sent to the hospital. Although the resident’s family contact information was later uploaded into the EMR and the family member was present in the facility that morning and spoke with the DON and administrator, the DON stated the family was not notified at the time the resident was sent out and was notified later when they came to the facility.
Failure to Document and Provide Catheter Care
Penalty
Summary
The facility failed to ensure catheter care was performed for a resident with an indwelling urinary catheter. The resident had physician orders for a catheter to gravity and for the catheter to be changed monthly, but there were no orders for catheter care located in the EMR. The resident’s quarterly assessment showed urinary retention, an indwelling urinary catheter, an ileostomy, partial to moderate assistance with mobility, dependence with toileting, and a urinary tract infection within the last 30 days. The resident’s care plan did not show that the resident performed their own catheter care and did not indicate that staff would provide catheter care. During interviews, the resident stated staff changed the catheter monthly but did not provide catheter care, and the resident reported performing their own peri care and catheter care with a washcloth every day, although this was not their preference. An LPN stated the resident received catheter care every shift, that the LPN provided the care, and that there should have been an order for it. The LPN also stated the resident should not do their own catheter care. The DON stated catheter care should have been documented, that the CNA did the catheter care, and that there was no order for catheter care even though there should have been one.
Call Light Not Within Reach
Penalty
Summary
The facility failed to ensure the call light was within reach for Resident #84. During observation, the resident was found in bed with the call light on the floor behind the head of the bed. A CNA later entered the room and picked up the call light from the floor. The facility policy stated that all call lights must be placed within each resident's reach and never on the floor or bedside stand. The resident stated they would yell out when they needed assistance, and the CNA stated the resident required two people for assistance with activities of daily living and was able to use a call light. The CNA also stated call lights were kept within residents' reach and checked constantly, but later acknowledged that the call light was on the floor and not within the resident's reach.
Incomplete Discharge Assessment and MDS Transmission
Penalty
Summary
The facility failed to ensure a resident discharge assessment was completed and transmitted to the State within 7 days of assessment for Resident #74. Resident #74’s electronic record showed diagnoses including fracture of the left femur, hypertension, and edema, and a Post-Discharge Plan of Care dated 02/28/26 showed the resident was discharged to home. However, there was no documentation that a discharge resident assessment was completed. During interview on 04/13/26, the DON stated the MDS coordinator was responsible for completing MDS assessments, and the administrator later reviewed the record and stated the discharge assessment had not been completed and should have been completed. The administrator also stated they were responsible for ensuring the MDS was completed and that they were the RN who signed off for completed MDS assessments.
Care Plan Did Not Address Hospice Services
Penalty
Summary
Facility failed to ensure a comprehensive care plan was developed to address hospice services for Resident #60, who had a diagnosis of chronic obstructive pulmonary disease and had been receiving hospice services since 04/17/25. The resident’s quarterly assessment dated 01/18/26 documented hospice services, and the care plan was revised on 01/30/26, but it did not address hospice services. During interviews on 04/15/26, the DON stated the resident’s care plan did not include hospice interventions, and the administrator stated the care plan should include hospice interventions and confirmed that it did not.
Medication Refrigerators Contained Staff Food and Drinks
Penalty
Summary
Medication storage was not kept separate from personal food and drink items in the facility's medication room. During observation, one small refrigerator contained tuberculin medication along with yogurt, two half-empty bottles of soda, and two bottles of water, one of which was partially empty. A second small refrigerator contained insulin bottles and insulin pens along with an ice cream sandwich and a packaged roast beef and cheddar sandwich. The facility's undated policy stated that medications must be stored separately from food and properly labeled. The DON stated that the food and drink items belonged to staff and should not have been stored in the medication refrigerators.
Failure to Notify Physician of Wound Condition Change
Penalty
Summary
The facility failed to notify the physician of a change in the condition of a wound for one of the residents reviewed. The resident had a displaced fracture of the left tibia and heart failure, and was receiving wound care to the sacral area three times a week as per a physician's order. On January 18, a nurse's note indicated the presence of a small open sore on the resident's right buttock. By January 20, the sore had become blackish in color and emitted a foul odor, yet there was no documentation that the physician had been informed of this change. Interviews with two LPNs and the administrator confirmed that significant changes in a wound should be reported to the physician immediately, which was not done in this case.
Failure to Implement Enhanced Barrier Precautions During Wound Care
Penalty
Summary
The facility failed to implement enhanced barrier precautions for a resident with a pressure ulcer. The Enhanced Barrier Precautions policy requires the use of gowns and gloves during high-contact resident care activities, such as wound care, to prevent the transfer of multidrug-resistant organisms. A resident with a stage four pressure ulcer on the sacral region was observed receiving wound care from an LPN and a CNA. The LPN initially began the wound care without wearing a gown and only donned it after starting the procedure. The CNA did not wear a gown at any point during the care. The LPN admitted to forgetting to wear a gown, and the CNA was unfamiliar with the enhanced barrier precautions. Another LPN confirmed that gowns should be worn when providing direct care to residents under enhanced barrier precautions.
Failure to Implement Abuse Policy for Multiple Residents
Penalty
Summary
The facility failed to implement its abuse policy for three of four sampled residents reviewed for abuse. Resident #1, diagnosed with anxiety and major depressive disorder, was involved in an incident where another resident slapped them. Although the physician and local police were notified, the facility administrator was not informed, and no state agency incident report or investigative findings were provided. Resident #2, with diagnoses including major depressive disorder and nicotine dependence, was involved in a similar incident where they slapped another resident, claiming it was in retaliation. The facility's incident report noted that the physician, DON, CCO, and administrator were informed, but again, no state agency report or findings were submitted. Resident #4, with chronic kidney disease and other conditions, was involved in an altercation in the dining area, resulting in a fall and head abrasion. The family, administrator, and physician were notified, but no report was made to the state agency. The administrator acknowledged that, according to the facility's abuse policy, these incidents should have been reported to the state agency within two hours, and thorough investigations should have been completed. The lack of timely reporting and comprehensive investigation constitutes a failure to adhere to the facility's abuse policy.
Failure to Report Abuse Allegations Timely
Penalty
Summary
The facility failed to report allegations of abuse immediately to the state agency, as required by their policy, for three of the four residents reviewed. The policy mandates that all alleged violations involving abuse, neglect, exploitation, or mistreatment must be reported immediately, but no later than two hours after the allegation is made. However, in the cases of three residents, the facility did not adhere to this policy. For Resident #1, an incident report documented that another resident slapped them, but there was no documentation that the state agency was notified. Similarly, for Resident #2, who was involved in the same incident, the facility failed to provide a state agency incident report. Resident #4 was involved in an altercation that resulted in a fall and injury, yet again, no report was made to the state agency. The administrator acknowledged the oversight upon reviewing the incidents and the facility's policy definition for abuse. Despite being notified of the incidents, the administrator did not initially consider them as abuse, which led to the failure in reporting. The administrator later admitted that, according to the facility's policy, these incidents should have been reported to the state agency within the stipulated two-hour timeframe, and thorough investigations should have been conducted. This failure to report and investigate in a timely manner constitutes a deficiency in the facility's adherence to its own policies and state regulations.
Failure to Investigate and Report Abuse Allegations
Penalty
Summary
The facility failed to thoroughly investigate allegations of abuse for three residents. Resident #1, diagnosed with anxiety and major depressive disorder, was reportedly slapped by another resident. Although the physician and local police were notified, there was no documentation that the facility administrator was informed, nor were any investigative findings reported to the state agency. Resident #2, with diagnoses including major depressive disorder and nicotine dependence, was involved in a similar incident where they reportedly slapped another resident. The incident was reported to the physician, DON, CCO, and administrator, but again, no state agency report or investigative findings were provided. Additionally, the police were involved, but the facility's documentation lacked resident or staff witness statements. Resident #4, with chronic kidney disease and other conditions, was involved in an altercation in the dining area, resulting in a fall and head abrasion. The family, administrator, and physician were notified, but no report was submitted to the state agency. The administrator acknowledged that, according to the facility's abuse policy, these incidents should have been reported to the state agency within two hours, and thorough investigations should have been completed. The lack of proper reporting and investigation constitutes a deficiency in handling abuse allegations as per the facility's policy and state regulations.
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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 Idabel
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Hill Nursing Home, Inc. | 0.5 mi | ★★★★★ | 0 | 0 |
| Broken Bow Health And Rehab | 9.7 mi | ★★★★★ | 7 | 1 |
| Clarksville Nursing Home | 24.2 mi | ★★★★★ | 14 | 0 |
| Focused Care At Clarksville | 24.7 mi | ★★★★★ | 8 | 0 |
| Bear Creek Healthcare Llc | 29 mi | ★★★★★ | 3 | 0 |
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