Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Oakridge Nursing Center during CMS and state inspections, most recent first.
A resident who was a full code did not receive effective CPR when found unresponsive, as staff failed to use a backboard, did not provide rescue breaths, and halted CPR due to confusion about the resident's code status. Staff were unable to definitively identify the code status during the emergency, and appropriate equipment was not utilized, resulting in a deficiency related to basic life support procedures.
The facility failed to maintain privacy and confidentiality for residents during care and medication administration. A resident with dementia did not have privacy during care, as curtains were not pulled and doors were left open. Additionally, an LPN left computer screens with residents' medication profiles visible at the nurse's station, compromising confidentiality. Staff acknowledged the need for privacy measures but did not implement them.
The facility failed to provide restorative therapy to two residents with limited ROM as per their care plans. One resident with multiple diagnoses missed eleven therapy sessions due to lack of documentation by CNAs. Another resident, with COPD and heart failure, received sporadic therapy despite expressing the need for it, and there was no documentation of therapy refusals in the EHR.
The facility failed to maintain a medication error rate below five percent, resulting in a 15.38% error rate. Errors included incorrect dosages of prednisone and aspirin administered to residents with chronic obstructive pulmonary disease and essential hypertension. The DON confirmed the availability of correct dosages in stock.
The facility failed to ensure proper infection control practices, as a staff member entered a COVID-19 resident's room without full PPE, and an LPN did not use hand sanitizer after touching a trash can during medication administration. These actions violated the facility's infection control protocols.
A resident with severe cognitive impairment was fed by an LPN standing at the foot of the bed, rather than sitting next to the resident, due to the absence of a chair in the room. This resulted in the resident not being assisted with eating in a dignified manner.
A resident with severe cognitive impairment and a history of falls was found without access to their call light, which was located at the foot of the bed. Despite the care plan's directive to keep the call light within reach, staff failed to ensure this during their visits. The resident expressed that they sometimes had to scream for help when the call light was not accessible. An LPN acknowledged the process for call lights but did not ensure accessibility until prompted.
Failure to Provide Effective CPR and Verify Code Status
Penalty
Summary
A deficiency occurred when facility staff failed to provide basic life support, including effective CPR, to a resident who was documented as a full code. The resident's medical records, advance directive, and physician's order all indicated that the resident had chosen to have CPR performed if required. On the date of the incident, the resident was found unresponsive, and a code was called. Staff began chest compressions while the resident was lying on a mattress, but did not use a backboard, which is necessary to ensure effective compressions on a soft surface. Additionally, no rescue breaths were provided using an Ambu bag or face shield, despite facility policy requiring ventilations with a compression-ventilation ratio of 30:2. During the code, confusion arose among staff regarding the resident's code status. Some staff members stopped CPR after being told by hospice that the resident was a DNR, even though facility records indicated the resident was a full code. This led to a period where CPR was halted until emergency medical technicians (EMTs) arrived, confirmed the resident's full code status, and resumed CPR. Interviews with staff revealed inconsistent accounts of who performed CPR, whether it was continuous, and whether appropriate equipment and techniques were used. Several staff members were unaware of the availability or purpose of a backboard, and none reported providing rescue breaths prior to EMT arrival. Facility documentation and staff interviews confirmed that the crash cart, which contained an Ambu bag, was present in the hallway, but staff did not utilize it for providing ventilations. The investigation also found that staff were unable to definitively identify the resident's code status during the emergency, resulting in the withholding of CPR for a resident who had requested it. The lack of effective CPR, including the absence of a backboard and rescue breaths, and the failure to verify and act on the resident's code status, constituted the deficiency.
Removal Plan
- All staff were in-serviced on code status, crash carts, code leader, CPR, and mock codes.
- A system to identify staff trained in CPR was put in place.
- Staff training on how to identify a resident's code status was completed.
- Members of the QAPI team met regarding CPR, mock codes drills, code status accuracy, verification with hospice providers, system review, post code briefings, and investigation completion.
Privacy and Confidentiality Breach During Care and Medication Administration
Penalty
Summary
The facility failed to ensure privacy and confidentiality for residents during care and medication administration. For Resident #31, who had dementia and generalized edema, privacy was not maintained during care activities. On multiple occasions, the privacy curtain was not pulled, and the door was left open while care was provided, exposing the resident's abdomen and allowing conversations about personal health information to be overheard by others in the room. Staff members, including a CNA, CMA, and LPN, acknowledged the need to pull curtains and close doors to maintain privacy but failed to do so during the observed interactions. Additionally, the facility did not secure protected health information during medication administration for three residents. An LPN left computer screens displaying residents' medication profiles visible at the nurse's station while administering medications in residents' rooms. This occurred for Residents #10, #170, and #173, with staff and an unknown resident present at the nurse's station, potentially exposing sensitive information. The LPN admitted to not locking the screen during the medication pass, which compromised the confidentiality of the residents' health information.
Failure to Provide Restorative Therapy for Residents with Limited ROM
Penalty
Summary
The facility failed to provide restorative therapy to two residents with limited range of motion (ROM), as required by their care plans. Resident #33, who had diagnoses including congestive heart failure, Parkinson's, COPD, and atrial fibrillation, was supposed to receive restorative care for bed mobility, ROM, and activities of daily living (ADLs) twice a week. However, there were eleven missed opportunities for providing this care from the order date until the survey date. The Director of Nursing (DON) acknowledged that the Certified Nursing Assistants (CNAs) probably did not document the restorative care, which was crucial for preventing worsening of the resident's condition. Resident #51, diagnosed with chronic obstructive pulmonary disease and heart failure, was also not provided with the prescribed restorative therapy. The resident's care plan included active-assisted ROM exercises for the upper extremities and active ROM/stretching for the lower extremities twice a week. Despite the resident expressing that they should be receiving therapy, documentation showed only sporadic provision of restorative therapy, with significant gaps in November and December 2024. The DON confirmed the lack of documentation for refusals, which should have been recorded in the electronic health record (EHR).
Medication Error Rate Exceeds Acceptable Threshold
Penalty
Summary
The facility failed to maintain a medication error rate of less than five percent, resulting in a 15.38% error rate during a medication pass observation. This deficiency involved multiple residents and medication errors. Resident #10, diagnosed with chronic obstructive pulmonary disease with acute exacerbation, was supposed to receive prednisone 5 mg daily for three days, ending on January 24, 2025. However, on the last day, the medication was not available, and the resident did not receive it until later in the afternoon. Additionally, Resident #10 was administered an incorrect dosage of azithromycin, receiving 250 mg instead of the prescribed 500 mg. Resident #173, with a diagnosis of essential hypertension, was prescribed aspirin 81 mg daily. However, the LPN administered aspirin 325 mg, mistakenly believing the dosages were equivalent. Similarly, Resident #170, who had a long-term use of antithrombotic/antiplatelets, was prescribed aspirin 81 mg but was given 325 mg instead. The DON later confirmed that the facility had both dosages in stock and expected the correct dosage to be administered as per the physician's order.
Infection Control Lapses in PPE Use and Medication Administration
Penalty
Summary
The facility failed to ensure proper infection prevention and control practices were followed, particularly in the use of Personal Protective Equipment (PPE) for residents on transmission-based precautions. Resident #46, diagnosed with COVID-19, was under droplet precautions as per a physician's order. However, a staff member, identified as transport #1, entered the resident's room wearing only a mask, without the required gown and goggles, despite the droplet precaution sign on the door. This breach was acknowledged by the administrator, who was aware of the incident. Additionally, during a medication administration observation, LPN #1 was seen adjusting a trash can bag without using alcohol-based hand rub (ABHR) before continuing with the medication pass. LPN #1 admitted to not maintaining infection control practices and was unsure of the facility's policy and procedure regarding infection control during medication administration. These lapses indicate a failure to adhere to the facility's COVID-19 plan and infection control protocols.
Failure to Assist Resident with Eating in a Dignified Manner
Penalty
Summary
The facility failed to ensure that a resident was assisted with eating in a dignified manner. The resident, who had severe cognitive impairment and required staff assistance with activities of daily living (ADLs), was observed being fed by an LPN while the LPN stood at the foot of the bed. This occurred during breakfast service, where the LPN fed the resident scrambled eggs and cereal without sitting next to the resident. The LPN later stated that there was no chair available in the resident's room to sit and assist with feeding, which led to the undignified manner of feeding.
Failure to Ensure Call Light Accessibility for Resident
Penalty
Summary
The facility failed to ensure that a call light was within reach for a resident with severe cognitive impairment and a history of falls. The resident, who required staff assistance with activities of daily living (ADLs), was observed without access to their call light, which was located at the foot of the bed. The resident expressed that they sometimes had to scream for help when the call light was not accessible. This situation was observed during a visit when a CNA and two LPNs entered and exited the resident's room without ensuring the call light was within reach. Despite the facility's care plan for falls, which documented the need to keep the call light within the resident's reach, staff failed to adhere to this directive. An LPN acknowledged the process for call lights was to keep them within reach and noted that the resident liked to hold the call light across their chest. However, the LPN did not ensure the call light was accessible until after being prompted. This oversight highlights a lapse in following the care plan and ensuring the resident's needs and preferences were reasonably accommodated.
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Illustrative
What surveyors actually found near you
We read the 66 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 Durant
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Four Seasons Rehabilitation & Care | 0.2 mi | ★★★★★ | 0 | 0 |
| The King's Daughters & Sons Nursing Home | 2.6 mi | ★★★★★ | 0 | 0 |
| Calera Manor | 11.1 mi | ★★★★★ | 0 | 0 |
| Southern Pointe Living Center | 12.9 mi | ★★★★★ | 4 | 0 |
| The Homestead Of Denison | 18.9 mi | ★★★★★ | 9 | 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.