Average — CMS composite of the measures below.
A standard survey is most likely before around August 2026
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 Shanoan Springs Nursing And Rehabilitation during CMS and state inspections, most recent first.
A resident with dysphagia, dementia, and a physician order for a mechanically soft diet without bread was incorrectly served a grilled cheese sandwich and salad instead of the ordered diet. Despite a care plan and policy requiring therapeutic diets to follow MD orders, dietary staff misread the diet card and, despite questioning the appropriateness of the meal, proceeded after confirmation from the cook. The resident subsequently experienced a choking episode during the meal, required emergency intervention, and was transported to the ED, where suctioning removed a small piece of lettuce and symptoms resolved.
A resident was transferred to the hospital due to respiratory symptoms, but the facility did not send the signed advance directive with the transfer. Although the face sheet and medication list were provided, hospital staff had to request the advance directive after the transfer, and staff confirmed it should have been sent.
An LPN failed to don gown and gloves before administering enteral medications to a resident on enhanced barrier precautions, despite facility policy and signage indicating the requirement for PPE during high-contact care activities. The resident had a traumatic brain injury and required assistance with personal care, and the administrator confirmed that PPE should be used for residents with devices such as PEG tubes.
The facility failed to maintain food safety and hygiene standards, with staff observed not washing hands after handling trash, improperly labeling and storing food, and neglecting hand hygiene while serving meals. The kitchen and storage areas were unclean, and staff did not use sanitizer when cleaning surfaces. The Dietary Manager and administrator acknowledged these lapses, indicating a systemic issue in adhering to professional standards.
The facility failed to ensure residents were offered the opportunity to formulate advance directives and accurately display code status. Three residents were not properly assisted in creating advance directives, and one resident's code status was incorrectly posted as full code despite having a DNR order. The social service director and DON acknowledged these oversights.
The facility failed to serve meals at an appetizing temperature, with food items such as pork chops, peas, and mac and cheese being served cold. A resident complained about cold food, and a test tray confirmed the issue. The Dietary Manager acknowledged the oversight in not checking food temperatures before service.
The facility failed to maintain proper infection control practices, with catheter tubing observed dragging on the floor for two residents, posing an infection risk. Additionally, wound care was not performed hygienically, and the facility lacked a comprehensive water management program to prevent Legionella growth. Staff interviews confirmed lapses in infection control protocols and incomplete documentation of water management activities.
The facility failed to protect residents from abuse and neglect, as evidenced by two incidents involving cognitively impaired residents. One resident was physically and verbally abused by a CNA during a shower, while another ingested disinfectant left unattended by a dietary aide. Both residents had dementia and required supervision, highlighting the facility's failure to ensure a safe environment.
A resident with cognitive impairment reported that a nurse used inappropriate language towards them. The incident was initially reported to a CMA, who did not escalate it immediately, advising the resident to speak to the nurse instead. The following day, the CMA informed the ADON, who notified the DON but did not complete an incident report. The facility's policy requires immediate notification of the Administrator or DON, which was not followed, leading to a delay in reporting the incident.
The facility failed to ensure accurate assessments for two residents. One resident's psychiatric medication reduction was incorrectly documented due to a discrepancy in consultation dates, while another resident's MDS assessment omitted several wounds, only noting two pressure ulcers. The DON acknowledged the need for corrections.
A facility failed to refer a resident with a new mental health diagnosis for a PASRR level II evaluation. The resident, transferred from another facility, had a PASRR level I assessment that did not include the new diagnosis of psychosis with risk of hallucinations and delusional paranoia. Despite a significant change assessment indicating severe cognitive impairment and a diagnosis of psychotic disorder, no referral for a PASRR level II evaluation was made.
A facility failed to administer nutritional supplements as recommended for a resident with a gastric tube. The resident, with a traumatic brain injury, had a physician's order for enteral feeding four times a day. A dietitian recommended increasing this to five times a day, but the recommendation was not communicated to the physician due to staff oversight in reviewing emails. As a result, the resident did not receive the necessary nutritional support.
A facility failed to follow physician's orders for changing oxygen tubing for a resident with chronic obstructive pulmonary disease and respiratory failure. The tubing, which was supposed to be changed twice a month, had not been replaced since early March, as confirmed by observations and the treatment administration record. The DON acknowledged the oversight.
A resident with severe cognitive impairment and a traumatic brain injury was observed with bed rails on both sides of their bed without a documented physician order or care plan. Although a consent was signed by the resident's representative, the DON stated it was not signed at the time of the request, indicating a deficiency in the facility's documentation and consent process.
The facility failed to ensure monthly drug regimen reviews and timely physician responses for two residents. One resident's medications were not reviewed or addressed by a physician for several months, while another resident's MRR request for a gradual dose reduction was not timely responded to by the physician. These actions did not comply with the facility's policy, affecting medication management.
The facility did not adhere to the planned menu, affecting meal service for residents. A resident requiring pureed meals did not receive a pureed roll, and another resident supposed to receive finger foods was not served the pork chop as indicated on the menu. Additionally, four meals were served without rolls, contrary to the menu plan.
The facility failed to properly dispose of kitchen garbage, affecting 48 residents. Staff were observed placing trash in a shopping cart outside the kitchen instead of taking it directly to the trash receptacle. The DM confirmed this practice, acknowledging that trash should be taken directly to the bin. A small bag of trash was later observed unattended in the cart.
A resident with intellectual disabilities and a need for assistance with personal care was not provided with scheduled showers as required. Despite being scheduled for four shower opportunities, the resident was only showered twice. The ADON confirmed that the staff should have informed the nursing staff if the resident refused or if they were unable to shower the resident.
Failure to Follow Physician‑Ordered Mechanically Soft Diet Resulting in Choking Episode
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident received a physician‑ordered mechanically soft diet without bread. The resident had medical diagnoses including cerebral infarction, dysphagia, and dementia, was severely cognitively impaired with a BIMS score of 5, and required a mechanically altered diet and set‑up assistance with eating. The resident’s care plan and physician order specified a mechanically soft texture diet with no bread due to dysphagia and cognitive deficits. On the date of the incident, the resident was served a grilled cheese sandwich and a side salad for the evening meal instead of the ordered mechanically soft diet without bread. The dietary staff did not follow the physician’s order or the care plan intervention to provide a mechanically altered diet with no bread. The facility’s policy stated that therapeutic diets would be served according to doctor orders, but this was not followed when the resident was given regular‑texture food items inconsistent with a mechanically soft diet. The cook who prepared the tray acknowledged misreading the dietary card, which resulted in the incorrect diet being provided, and the dietary aide who delivered the tray reported questioning whether a grilled cheese sandwich and salad were appropriate for a mechanically soft diet but relied on the cook’s confirmation that they were. The dietary manager and administrator stated that the cook and dietary aide had not received adequate training regarding therapeutic diets and that the staff should have recognized the meal items were not consistent with the ordered mechanically soft diet without bread. As a result of receiving the incorrect meal, the resident experienced a choking episode during dinner, was observed unable to move air effectively, required abdominal thrusts, and was sent to the hospital, where suctioning revealed a small piece of lettuce before the resident’s symptoms resolved.
Removal Plan
- Completed an immediate diet order audit for all residents to ensure no additional meals were served without verification of the residents’ ordered diet consistency.
- Implemented a monitoring tool to verify meal trays matched physician-ordered diets for all residents.
- Registered dietician observed dietary preparation processes and provided additional re-education as needed.
- Scheduled dining room nursing assignments to increase staff presence and supervision during meal service.
- Conducted a multi-disciplinary quality assurance meeting and completed a root cause analysis to determine contributing factors and identify improvements needed to prevent recurrence.
- Speech therapy assessed Resident #3 and added gravy/sauce to ground meat items to improve moisture and aid in swallowing and continued monitoring during meals to ensure safety with updated dietary modification.
- In-serviced dietary and nursing staff on the importance of following physician-ordered diets.
- Implemented a two-step meal tray verification policy requiring dietary staff to verify diet orders and tray accuracy during tray preparation and nursing staff to conduct a second verification prior to tray delivery to residents.
- Suspended dietary staff involved in the incident pending investigation.
Failure to Send Advance Directive During Resident Transfer
Penalty
Summary
The facility failed to ensure that a resident's advance directive was sent with them during a transfer to the hospital. According to facility policy, advance directive information should be communicated to the receiving provider when a resident is transferred or discharged. In this case, a resident experiencing labored breathing and coughing up thick green phlegm was transferred to the hospital. Although the face sheet and medication list were sent, the signed advance directive was not included. Hospital staff subsequently had to call the facility to request a copy of the advance directive, confirming that it was not provided at the time of transfer. Interviews with the DON and an LPN confirmed that the advance directive should have been sent but was omitted.
Failure to Use PPE During Enhanced Barrier Precautions
Penalty
Summary
The facility failed to ensure proper use of personal protective equipment (PPE) for a resident requiring enhanced barrier precautions. During observation, an LPN entered the room of a resident with a traumatic brain injury and a need for assistance with personal care to administer medications via enteral tube, but did not don gown and gloves as required by the facility's Enhanced Barrier Precautions policy. The policy specifies that gown and glove use is necessary during high-contact resident care activities, and the medication administration policy also lists PPE as required equipment. The LPN acknowledged that the signage outside the resident's room indicated the need for enhanced barrier precautions and admitted that gown and gloves should have been worn prior to administering the medication. The administrator confirmed that PPE is required for direct care of residents with devices such as PEG tubes.
Food Safety and Hygiene Deficiencies in Facility
Penalty
Summary
The facility failed to adhere to professional standards for food service safety, as observed during a survey. On the initial tour of the kitchen, a staff member was seen handling trash and then returning to food preparation without washing their hands. Additionally, numerous food items in the refrigerator and freezer were not labeled or dated, and some were left open to air. The kitchen and storage areas were found to be unclean, with debris and dirt present, and scoops were improperly left in dry ingredient bins. During a subsequent tour, further violations were noted, including staff failing to use sanitizer when cleaning surfaces and neglecting hand hygiene after touching potentially contaminated items. Staff members were observed entering the kitchen and handling food without washing their hands or wearing hair nets. The Dietary Manager acknowledged these lapses, stating that proper procedures were not being followed, such as labeling food items and maintaining cleanliness. In the dining area, staff were seen serving meals without performing hand hygiene between residents and balancing meal plates against their clothing. The administrator confirmed that nursing staff should use hand sanitizer between residents and wash their hands after every few meals served. These observations indicate a systemic failure in maintaining food safety and hygiene standards, potentially compromising resident safety.
Failure to Manage Advance Directives and Code Status
Penalty
Summary
The facility failed to ensure that residents were offered the opportunity to formulate an advance directive or implement their choice to do so. Three residents were affected by this deficiency. One resident, with diagnoses including atrial fibrillation and COPD, had an advance directive acknowledgment form signed but lacked an actual advance directive in their records. The social service director admitted to not discussing the advance directive with the resident, instead relying on the resident's POA. Another resident, diagnosed with COPD and PVD, expressed interest in creating an advance directive, but the care plan incorrectly documented that they already had one. The DON later removed this incorrect documentation. A third resident, with PVD and dementia, also expressed interest in an advance directive through their POA, but no follow-up was conducted by the social service department. Additionally, the facility failed to post the correct code status information for a resident with multiple sclerosis and dementia. Despite having a physician's order for a DNR, the resident's room displayed a green name tag indicating full code status. The DON acknowledged the oversight after checking the charts and doorframes but missed correcting this resident's code status. These deficiencies highlight lapses in the facility's processes for managing advance directives and ensuring accurate code status information is displayed.
Failure to Serve Meals at Appetizing Temperature
Penalty
Summary
The facility failed to ensure that meals were served at an appetizing temperature, affecting the quality of food provided to residents. On April 17, 2024, during the noon meal service, the pork chops were initially removed from the oven at a temperature of 184 degrees Fahrenheit and placed on the steam table without checking the temperature of other food items. The meal service began at 12:01 p.m., but the steam table was not checked for temperature before service. At 12:20 p.m., the Dietary Manager (DM) acknowledged that the food should have been temped before serving, and a pork chop on top of the stack was found to be at 106 degrees Fahrenheit. Additionally, a resident complained about receiving cold food on April 15, 2024. On April 17, 2024, a test tray was taken to the north hall, and the temperatures of the food items were recorded. The pork chop was 115 degrees Fahrenheit, the peas were 105 degrees Fahrenheit, the mac and cheese noodles were 107 degrees Fahrenheit, and the apple dessert was 81.5 degrees Fahrenheit, all of which were cold to taste. The test meal was also missing a roll. The DM stated that there had been no complaints of cold food but agreed that the food should have been served at a palatable temperature.
Infection Control and Water Management Deficiencies
Penalty
Summary
The facility failed to maintain proper infection prevention and control practices, as evidenced by several observations and interviews. One resident with a suprapubic catheter was repeatedly observed with the catheter tubing dragging on the floor, which poses a significant infection control risk. Despite the care plan indicating the need for enhanced precautions due to the resident's increased risk of infection, staff did not consistently ensure the catheter tubing was kept off the floor. Interviews with staff confirmed that the catheter tubing should not have been dragging on the floor, highlighting a lapse in adherence to infection control protocols. Another resident with a catheter was also observed with the catheter tubing dragging on the floor, including instances where the tubing touched the sole of the resident's shoe. This further indicates a systemic issue with catheter management and infection control practices within the facility. The infection preventionist acknowledged that the catheter tubing should not have been in contact with the floor, underscoring a failure to implement proper infection control measures. Additionally, the facility did not implement a comprehensive water management program to prevent the growth of Legionella and other waterborne pathogens. The facility's documentation was incomplete, lacking evidence of a detailed water system diagram or regular team meetings to address water management. The infection preventionist and administrator were not fully aware of the program's status, and the maintenance staff admitted to a lack of documentation for routine cleaning activities. This indicates a significant oversight in maintaining a safe water system, as required by the facility's policy.
Failure to Protect Residents from Abuse and Neglect
Penalty
Summary
The facility failed to protect residents from abuse and neglect, as evidenced by two separate incidents involving residents with cognitive impairments. In the first incident, a certified nursing assistant (CNA) placed their hand over a resident's mouth and nose on three occasions during a shower, and verbally abused the resident by telling them to shut up. This incident was reported by a hospitality aide who witnessed the abuse, and another staff member heard the resident screaming. The resident involved had dementia with behavioral disturbances and required extensive assistance with activities of daily living. In the second incident, a resident with dementia and Alzheimer's disease, who was severely impaired in cognition and required supervision with eating, ingested Purell Surface Disinfectant. The disinfectant was left unattended on a cart in the dining room by a dietary aide, allowing the resident to access it. The resident was seen with the bottle pointed towards their mouth, and the incident was reported by another resident. The dietary aide did not witness the ingestion but found the resident with the bottle in hand. The resident's care plan noted poor impulse control and the need for interventions to mitigate behaviors. Both incidents highlight the facility's failure to ensure a safe environment for residents, particularly those with cognitive impairments. The facility did not adequately supervise or control access to potentially harmful substances, nor did it prevent or promptly address abusive behavior by staff. These deficiencies were identified through observations, record reviews, and interviews conducted during the survey.
Delayed Reporting of Abuse Allegation
Penalty
Summary
The facility failed to report an allegation of abuse within the required two-hour timeframe for a resident diagnosed with atrial fibrillation, COPD, and chronic pain. The resident, who was moderately impaired with cognition and required assistance with most activities of daily living, reported that a nurse used inappropriate language towards them. The incident was initially reported by the resident to a CMA on a Sunday night, but the CMA did not escalate the report immediately, believing the resident might exaggerate the situation. Instead, the CMA advised the resident to speak directly with the nurse involved. The following day, the CMA reported the incident to the Assistant Director of Nursing (ADON), who then informed the Director of Nursing (DON) and a DON from a sister facility. However, the ADON did not complete an incident report. The facility's policy requires immediate notification of the Administrator or Director of Nursing Services in cases of suspected abuse, but this protocol was not followed, resulting in a delay in reporting the incident to the Administrator until two days later.
Inaccurate Resident Assessments for Psychiatric and Wound Care
Penalty
Summary
The facility failed to ensure accurate resident assessments for two residents. The first resident had multiple psychiatric diagnoses, including anxiety disorder, major depressive disorder, bipolar disorder, and schizophrenia. A quarterly assessment inaccurately documented a gradual dose reduction (GDR) attempt for antipsychotic medication on a date that was not correct. The MDS coordinator, new to the position, found a discrepancy in the date of a psychiatric consultation note, which was signed and dated differently. The Director of Nursing (DON) confirmed that the psychiatrist had made medication changes that the attending physician did not approve, leading to an incorrect date on the MDS for medication reduction. The second resident had several diagnoses, including a stage 3 pressure ulcer, peripheral vascular disease (PVD), and lymphedema. The care plan documented multiple wounds, but the quarterly assessment only noted two unhealed stage 3 pressure ulcers, omitting other wounds. A wound progress note later detailed additional wounds, including a non-pressure wound and a lymphedema wound, which were not captured in the MDS assessment. The DON acknowledged the need for a correction in the wound section of the MDS assessment, as it failed to include all the resident's wounds.
Failure to Refer for PASRR Level II Evaluation
Penalty
Summary
The facility failed to refer a resident with a new mental health diagnosis for a PASRR level II evaluation. The resident, who was transferred from another facility, had a PASRR level I assessment dated 06/30/10, which documented diagnoses including multiple sclerosis, neurogenic bladder, paraplegia, sebaceous cysts, and a syndrome. Upon admission, the resident had additional diagnoses, including dementia with agitation, delusional disorder, cognitive communication deficit, and dementia with behavioral disturbances. A significant change assessment later documented severe cognitive impairment and a diagnosis of psychotic disorder. The care plan was revised to include a diagnosis of psychosis with risk of hallucinations and delusional paranoia. However, the Director of Nursing confirmed that the diagnosis of psychosis was not documented on the PASRR level I, and no referral for a PASRR level II evaluation was made.
Failure to Administer Recommended Nutritional Supplements
Penalty
Summary
The facility failed to ensure that nutritional supplements were administered as recommended for a resident with a gastric tube, leading to a deficiency in maintaining the resident's health. The resident, who was admitted with a diffuse traumatic brain injury and other conditions requiring personal care assistance, had a physician's order for enteral feeding with TwoCal HN four times a day. However, a dietitian later recommended increasing the feeding to five times a day. This recommendation was not communicated to the physician, as the facility staff, including the ADON and DON, did not review the dietitian's email containing the updated feeding instructions. Consequently, the resident did not receive the recommended nutritional support.
Failure to Follow Oxygen Tubing Change Orders
Penalty
Summary
The facility failed to adhere to physician's orders for oxygen tubing care maintenance for a resident who was dependent on supplemental oxygen due to chronic obstructive pulmonary disease and respiratory failure. The physician's order specified that the oxygen tubing should be changed on the 5th and 20th of each month during the night shift. However, observations made on multiple occasions in April 2024 revealed that the resident was using oxygen tubing dated 03/06/24, indicating that the tubing had not been changed as per the physician's order. The treatment administration record for April 2024 also lacked documentation of any tubing changes since 03/06/24. The Director of Nursing confirmed that the tubing should have been changed on the 5th of April 2024.
Inappropriate Use of Bed Rails Without Proper Documentation
Penalty
Summary
The facility failed to ensure the appropriate use of side rails for a resident who was reviewed for side rails. The resident, who was admitted with diagnoses including diffuse traumatic brain injury and severe cognitive impairment, was observed lying on an air mattress with bed rails on both sides of the bed. However, the resident's electronic health record did not document a physician order for the use of bed rails, nor was there a care plan addressing their use. Although the resident's records contained a consent signed by the resident's representative for bed rails, the Director of Nursing stated that the representative had not signed a consent at the time the bed rails were requested. This indicates a lack of proper documentation and consent process for the use of bed rails, which is a deficiency in the facility's compliance with safety protocols.
Failure in Monthly Drug Regimen Review and Physician Response
Penalty
Summary
The facility failed to ensure that a consultant pharmacist conducted a monthly drug regimen review (MRR) for each resident, as required by their policy. Specifically, for two residents, the pharmacist did not review the medication regimen monthly, and the physician did not respond to the MRR requests within the time frame specified by the facility's policy. One resident, with diagnoses including anxiety disorder, major depressive disorder, bipolar disorder, and schizophrenia, had medications listed in a MRR dated September 2023, but there was no physician response found. Additionally, a MRR request in January 2024 for the same resident's medications was not addressed by the physician, and no MRR was found for February 2024. Another resident, diagnosed with generalized anxiety disorder, major depressive disorder, bipolar disorder, and dementia, had a MRR request in November 2023 for a gradual dose reduction (GDR) of Rilutek, which the physician disagreed with, but the response was not timely. Furthermore, the facility could not provide a MRR for January 2024 for this resident. These deficiencies indicate a failure to adhere to the facility's policy regarding timely MRRs and physician responses, potentially impacting the residents' medication management.
Failure to Follow Menus in Meal Service
Penalty
Summary
The facility failed to ensure that menus were followed, resulting in discrepancies in meal service for residents. On April 17, 2024, the noon meal was supposed to include french onion pork chops, pork gravy, white cheddar mac and cheese, green peas, a wheat dinner roll, margarine, apple, milk, and coffee. However, during meal service, it was observed that four meals were served without rolls, and a resident who required pureed meals did not receive a pureed roll. Additionally, a resident who was supposed to receive finger foods was served butter noodles, white cheddar mac and cheese, and green beans, but not the pork chop as indicated on the menu. The dietary manager confirmed that the resident should have received a pork chop cut into finger food size. These observations indicate that the facility did not adhere to the planned menu, affecting the nutritional needs of the residents.
Improper Disposal of Kitchen Garbage
Penalty
Summary
The facility failed to properly dispose of garbage from the kitchen, affecting 48 residents who received services from the kitchen. On April 15, 2024, at 8:25 a.m., a staff member was observed removing trash from the kitchen garbage can and placing it in a shopping cart located outside by the storage building instead of taking it directly to the trash receptacle bin at the street. Later, at 9:03 a.m., the Dietary Manager (DM) confirmed that staff had been using the shopping cart to temporarily store trash before taking it to the trash receptacle, acknowledging that the trash should have been taken directly to the bin. On April 17, 2024, at 11:25 a.m., a small bag of trash was again observed unattended in the shopping cart outside by the storage room.
Failure to Provide Scheduled Showers for Resident
Penalty
Summary
The facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain grooming and personal hygiene. A resident with a laceration without foreign body of the right eyelid and periocular area, who required assistance with personal care and had intellectual disabilities, was admitted to the facility. The care plan indicated that the resident required extensive assistance from one staff member for showering or bathing. A Medicare five-day assessment confirmed the need for substantial to maximal assistance with bathing. However, documentation revealed that the resident was only showered twice during their stay, despite being scheduled for four opportunities. The Assistant Director of Nursing (ADON) confirmed that the resident was on a 7 p.m. to 7 a.m. shower schedule and acknowledged that the staff should have informed the nursing staff if the resident refused or if they were unable to shower the resident. The documentation indicated that the resident did not receive showers as scheduled.
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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.
Illustrative
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Nursing homes near Chickasha
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Chickasha Nursing Center, Inc | 0.3 mi | ★★★★★ | 0 | 0 |
| Cottonwood Creek Skilled Nursing & Therapy | 1.7 mi | ★★★★★ | 0 | 0 |
| Glenhaven Retirement Village | 1.7 mi | ★★★★★ | 0 | 0 |
| Anadarko Nursing & Rehab | 17.3 mi | ★★★★★ | 9 | 0 |
| Senior Village Healthcare | 18.2 mi | ★★★★★ | 0 | 0 |
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