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 Premier Health Care Center during CMS and state inspections, most recent first.
A resident with limited mobility and moderate cognitive impairment was transported by a CNA in a facility van while seated in a wheelchair that was required to be secured with a 5‑belt restraint system. The CNA reported locking the wheelchair wheels and fastening all belts, but during the trip the van overheated, the CNA slowed in a construction zone, and the wheelchair flipped backward, leaving the resident on the floor. Hospital records documented an acute subdural hematoma and cervical fracture from a fall from the wheelchair during van transport. Subsequent testing of the van’s restraint system showed the wheelchair could only flip if both front floor straps were not fastened, and the Administrator concluded the front belts must not have been secured. Interviews and record reviews revealed no documented training or competency validation in transportation safety or wheelchair securement for the aides involved, despite a written policy requiring such training, and the Administrator acknowledged there were no maintenance logs or routine safety inspections for the van.
The facility did not ensure that multiple full-time nurse aides obtained CNA certification or completed a state-approved training and competency evaluation program within four months of hire, as required by regulation and the facility’s own job description. Record reviews showed that several aides had been employed beyond four months with employability checks indicating no CNA certification, and interviews with the Office Manager and Administrator confirmed they were aware many aides were past the certification deadline. Leadership cited difficulty obtaining certification and recruiting CNAs in a rural area and noted they were awaiting or had just obtained approval to conduct a CNA class, while acknowledging ongoing noncompliance that could affect the appropriateness of care provided.
The facility failed to maintain its transport van in safe operating condition, as there were no maintenance logs, routine inspections, or documented safety checks. An administrator acknowledged that the van was not routinely inspected. A CNA reported that while transporting a resident, the van began to overheat in a construction zone with no place to exit, prompting her to call maintenance and slow down after seeing a yellow warning light. This deficiency was cited for failure to keep essential equipment working safely.
The facility failed to properly store and label food items in the kitchen's dry storage, with several items found unsealed and without necessary dates. This was attributed to the absence of the Dietary Manager, who was responsible for labeling, leading to a risk of foodborne illnesses.
A facility failed to maintain accurate medical records for a resident with severe cognitive impairment, resulting in outdated hospice care orders. The resident was discharged from one hospice and admitted to another, but the facility's records did not reflect this change. The DON acknowledged the oversight and its potential impact on care, attributing the error to staff oversight.
The facility failed to maintain an effective infection prevention and control program, lacking Enhanced Barrier Precautions (EBP) signage and Personal Protective Equipment (PPE) for residents with indwelling medical devices and those in COVID-19 isolation. Observations showed missing PPE and inadequate signage, with staff untrained on EBP requirements. The Director of Nursing and Administrator acknowledged the deficiencies, citing delays and lack of attention to infection control measures.
A facility failed to develop a comprehensive care plan for a resident with multiple medical conditions, including Diabetes Mellitus and Gout. The care plan lacked interventions and goals for several diagnoses, despite the resident receiving various medications. The DON confirmed that care plans should address all diagnoses and be updated with significant changes, but this was not done, potentially risking the resident's care.
A resident's care plan was not updated following a fall that resulted in a clavicle fracture and a physician's order for a figure eight binder. Despite the resident's complex medical history, the care plan remained unchanged, which was acknowledged by the DON as a failure to meet the facility's policy for timely updates after significant changes in condition.
A resident with an indwelling urinary catheter was at risk for infection due to the facility's failure to secure the urine collection bag off the floor, contrary to policy. Despite the resident's awareness of catheter care, staff interviews revealed non-compliance with infection control training, as the bag was observed lying on the floor. The DON and ADON, responsible for training, could not explain the oversight.
The facility failed to post 'Oxygen in Use' signs for three residents using oxygen, as required by policy. Observations revealed that these residents, who had varying levels of cognitive impairment, were using oxygen without the necessary signage on their doors. The ADON and DON acknowledged the oversight and the importance of such signage in meeting care needs.
Improper Wheelchair Securement During Van Transport Leads to Resident Injury
Penalty
Summary
The deficiency involves the facility’s failure to ensure the resident environment remained as free of accident hazards as possible and to provide adequate supervision and assistive devices to prevent accidents during van transportation. A female resident with a history of left femur fracture, anxiety, and depression, and with moderate cognitive impairment (BIMS score of 10), required substantial/maximal assistance for sit-to-stand and car transfers, and walking was not attempted due to her medical condition. Her care plan identified limited physical mobility related to a fractured hip and indicated she required assistance by one staff to walk. Despite these needs, she was transported in the facility van in a wheelchair and was not properly secured using the required 5‑seatbelt restraint system. On the day of the incident, the CNA assigned to transport the resident took her to what turned out to be the wrong orthopedic office and then returned her to the van to go to the correct location. The CNA reported pushing the resident up the wheelchair ramp, locking the wheelchair wheels, and fastening the two rear seatbelts that secured the wheelchair to the floor. She then moved to the front of the van and stated she fastened the remaining three belts, which included two front straps securing the wheelchair to the floor and a lap belt over the resident’s lap. While driving, the van began to overheat in a construction zone, and as the CNA slowed down after seeing a yellow light, she heard a noise and saw that the resident’s wheelchair had flipped backwards, with the resident on the floor at the back of the van. The CNA reported that the resident’s front safety belt was unclamped and that she had to unbuckle the lap belt to move the wheelchair to reach the resident. The resident was transported by EMS to the hospital, where records documented an acute subdural hematoma and a cervical fracture following a fall from a wheelchair while being transported in a van. When interviewed in the hospital, the resident, who was wearing a cervical collar, recalled that the CNA hit the brakes and the wheelchair flipped; she stated she did not know if all straps were fastened and that she had not unfastened any safety belts herself. Facility staff later tested the van’s 5‑belt restraint system with an empty wheelchair and found that when all four floor straps and the lap belt were secured, the wheelchair could not be flipped, and even with the lap belt removed or one front strap unfastened, the chair still would not budge. The wheelchair only flipped backwards when both front straps were unfastened, leading the Administrator to state that the only way the chair could have flipped was if the two front safety belts were not fastened. Further review revealed systemic failures related to transportation safety. The Office Manager initially stated that transportation aides were trained and had demonstrated competency in wheelchair securement and safety belt placement before transporting residents, but later acknowledged there was no evidence of such training or competencies for the CNA involved or for the current transportation aide. Personnel file reviews for both aides showed no documentation of training related to transportation safety or wheelchair securement, despite a facility policy requiring that staff responsible for transportation be trained and demonstrate competency in wheelchair securement procedures, with competency documented prior to independent transport duties. Additionally, the Administrator reported that the van had no maintenance logs, no records of routine safety checks, and was not inspected routinely, even though the van had recently overheated during the incident. These inactions and lack of documented training, competency validation, and vehicle safety oversight contributed to the improper securement of the resident’s wheelchair and the resulting accident and injuries.
Removal Plan
- Ceased all resident transportation via van and wheelchair transfers requiring safety restraint usage; ceased all other facility transports unless staff were trained by nursing staff trained in safe transport and proper safety restraints.
- Required verification that safety restraints are applied correctly and staff supervision is present prior to movement; implemented and used a transport check sheet/checklist located at the nurses station; trained all transport staff on proper use of the transport checklist.
- Required that no resident is transported or transferred using the facility van until safety checks are completed and documented; completed staff in-service/sign-off for training and notification of safety checks.
- Required licensed nursing staff trained in van safety transportation to provide supervisory oversight for all transfers involving wheelchairs.
- Completed a 100% audit of all residents transported outside the facility and identified residents likely to be affected; updated care plans and implemented additional supervision for any resident identified as high risk.
- Established a standardized transportation and wheelchair restraint checklist process; implemented a Skilled Nursing Facility Transportation Safety Checklist and Wheelchair Van Restraint Safety Checklist for all nursing staff.
- Provided staff education and competency validation (return demonstration) for all staff involved in resident transfers/transportation (nurses, CNAs, drivers) on wheelchair brake locking, proper restraint use, and supervision requirements; prohibited staff from transport duties until competency is demonstrated.
- Trained all nurses on proper procedure for transports with a wheelchair upon hire and annually.
- Updated care plans to clearly identify supervision and transport requirements.
- Created/revised transportation and accident prevention policy to include training requirements, safety checklist, transportation safety, and restraint checklist.
- Adopted a zero tolerance policy for noncompliance with transportation safety procedures; made in-service mandatory for current staff and before starting first shift for new staff.
- Implemented supervisory sign-off requirement for all external transports.
- Implemented weekly preventive maintenance checks for wheelchairs and van restraints.
- Implemented monitoring/oversight: DON/designee conducts daily audits of transportation documentation, then weekly; reviews findings during QAPI meetings; initiates immediate corrective action for any noncompliance.
- Incorporated transportation safety training into new hire orientation and required annual competency validation for all applicable staff; continued ongoing QAPI monitoring to ensure sustained compliance.
- Established a standardized maintenance checklist to be reported monthly in QAPI meetings with the IDT.
Failure to Ensure Nurse Aide Certification and Competency Within Required Timeframe
Penalty
Summary
The facility failed to ensure that nurse aides working more than four months on a full-time basis were trained, competent, and had completed a state-approved training and competency evaluation program, as required. Record review showed that multiple nurse aides (NA-F, NA-I, NA-K, and NA-L) had been hired and working full time without obtaining CNA certification within four months of hire. Employability status checks for these aides, conducted months after their hire dates, documented that they had no CNA certification. The facility’s own job description for nurse aides required that they either have completed a state-approved training and competency evaluation program and hold a current state certificate, or be enrolled in an approved competency training program and perform only services for which they had demonstrated competence. During interviews, the Office Manager acknowledged that nurse aides were required to be certified within four months of hire and stated she was aware that many aides were past that deadline. She reported the facility was waiting for approval to conduct a nurse aide class. The Administrator also acknowledged awareness that many nurse aides were beyond the four-month deadline for certification, explaining that it was very hard to get people certified and difficult to find CNAs in a rural area. She stated the facility had just become certified to offer a CNA class but was uncertain whether the class could be held due to an Immediate Jeopardy that had been called and expressed uncertainty about how to proceed. The report notes that this failure could place residents at risk for receiving inappropriate care from individuals whose skill level was not known.
Failure to Maintain and Routinely Inspect Facility Van
Penalty
Summary
The facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition by not ensuring the facility van was properly maintained. During an interview, the Administrator reported there were no maintenance logs or routine safety or maintenance checks for the van, and confirmed the van was not inspected routinely. In a separate interview, a CNA stated that while transporting a resident, the van began to overheat while she was in a construction zone with no available exit. She reported calling the maintenance staff by phone and then noticing a yellow light on the dashboard as she began to slow down. The report states that this failure could place residents at risk of injury due to not being supervised and at risk of serious bodily harm, physical impairment, hospitalization, or death.
Improper Food Storage and Labeling in Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety, specifically in the storage and labeling of food items in the kitchen's dry storage area. During an observation, it was noted that several food items, including a bag of toasted oats, cornbread mix, and various plastic containers of cereals and dry goods, were not properly sealed or labeled with necessary information such as open dates, expiration dates, or use-by dates. This lack of proper labeling and sealing could potentially expose residents to foodborne illnesses. Interviews with dietary staff revealed that there was an expectation for all food items to be labeled with the date they arrived, the date they were opened, and the expiration date. However, the dietary cook was unaware of why the labeling was not done, and the Dietary Manager (DM) admitted that the failure occurred due to her absence from work due to illness, as she was responsible for labeling and dating the products. The Assistant Dietary Manager (ADM) also confirmed that the failure was due to the DM's absence and acknowledged that the kitchen staff did not follow the facility's policy on food storage and labeling, which could lead to foodborne illnesses if not addressed.
Inaccurate Hospice Orders for Resident
Penalty
Summary
The facility failed to maintain accurate and complete medical records for a resident, specifically regarding the resident's hospice care orders. The resident, who had severe cognitive impairment and was receiving hospice care, was discharged from one hospice provider and admitted to another. However, the facility's records did not reflect this change, as there was no order to discharge from the initial hospice or to admit to the new hospice. This oversight was identified during a review of the resident's physician orders, which inaccurately indicated the resident was still under the care of the initial hospice provider. During interviews, the Director of Nursing (DON) acknowledged that the resident's orders should have been updated to reflect the current hospice care provider. The DON explained that the responsibility for entering and monitoring orders fell to the charge nurse, herself, and the Assistant Director of Nursing (ADON). The failure to update the orders was attributed to staff oversight, which could have led to potential delays in care due to contacting the wrong hospice provider. The facility was unable to provide requested policies on maintaining accurate records at the time of the exit conference.
Inadequate Infection Control Measures in LTC Facility
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by the lack of Enhanced Barrier Precautions (EBP) signage and Personal Protective Equipment (PPE) availability for several residents. Specifically, residents with indwelling medical devices such as urinary catheters and those with open wounds did not have the necessary EBP signage or PPE available for staff providing care. This deficiency was observed in residents with conditions requiring additional precautions, such as suprapubic urinary catheters and open wounds, yet there were no orders for EBP or appropriate signage to guide staff in infection control measures. Additionally, the facility did not ensure that PPE was readily available for residents placed in isolation due to positive COVID-19 tests. Observations revealed that isolation rooms lacked PPE outside the doors, and signage did not provide adequate instructions for staff or visitors. The Director of Nursing (DON) acknowledged the absence of PPE and signage, attributing it to delays in implementation. Staff interviews further revealed a lack of training on EBP, with some staff unaware of the requirements and procedures for infection control. The facility's policies on COVID-19 and EBP were not effectively implemented, as evidenced by the lack of PPE availability and inadequate staff training. The Administrator admitted to being aware of the EBP requirement but cited being too busy to address it. The DON and Assistant Director of Nursing (ADON) were responsible for infection control training, yet there was a clear gap in compliance and understanding among staff. This failure to implement an effective infection prevention and control program could lead to cross-contamination and increased risk of infection among residents.
Failure to Implement Comprehensive Care Plan for Resident
Penalty
Summary
The facility failed to develop and implement a comprehensive and person-centered care plan for a resident with multiple medical conditions, including Type 1 Diabetes Mellitus and Gout. The care plan did not include problems, interventions, or goals for several diagnoses such as Paroxysmal Atrial Fibrillation, Obesity, and Osteoarthritis, among others. This oversight was identified during a review of the resident's comprehensive care plan and was confirmed by the Director of Nursing (DON), who acknowledged that care plans should address all diagnoses and be updated with any significant changes. The resident, a cognitively intact female, was admitted with a range of diagnoses including Hypothyroidism, Hypertension, and Shortness of Breath, and was receiving medications such as Metoprolol Tartrate, Losartan, and Metformin HCL. Despite these conditions and treatments, the care plan lacked measurable objectives and timeframes to address the resident's needs. The facility's policy mandates that a comprehensive care plan be completed within seven days after the initial MDS assessment, but this requirement was not met, potentially placing the resident at risk of not receiving necessary care.
Failure to Update Care Plan After Resident's Fall and Injury
Penalty
Summary
The facility failed to revise the care plan for a resident following a significant change in their medical condition. Specifically, the care plan was not updated to include a recent fall resulting in a left distal clavicle fracture and the subsequent physician's order for a figure eight binder (clavicle support brace). This oversight was identified during a review of the resident's care plan, which had not been updated since its initiation, despite the resident's injury and new medical orders. The resident in question is an elderly male with a history of multiple medical conditions, including nonrheumatic aortic valve stenosis, congestive heart failure, nicotine dependence, epilepsy, hypertension, and chronic obstructive pulmonary disease. The Director of Nursing (DON) acknowledged that care plans should be updated with any significant change in a resident's condition and at least quarterly. However, the DON was unaware of the reason for the failure to update the care plan, which could potentially impact the resident's care.
Failure to Secure Urinary Catheter Collection Bag
Penalty
Summary
The facility failed to ensure appropriate treatment and services for a resident with an indwelling urinary catheter, specifically in preventing urinary tract infections. The deficiency was identified when the resident's urine collection bag was observed lying on the floor, which is against the facility's policy that mandates catheter tubing and drainage bags be kept off the floor. This oversight was noted during an observation and confirmed through interviews with staff, who acknowledged that the collection bag should be hung from the bed frame to minimize infection risk. The resident involved was a female with multiple medical diagnoses, including anxiety, obesity, high blood pressure, heart disease, and a history of cervical cancer, among others. Despite the resident's moderate cognitive impairment, she was aware of the catheter care routine and reported no issues with the catheter. However, staff interviews revealed a lack of compliance with infection control training, as the urine collection bag was not properly secured. The Director of Nursing and Assistant Director of Nursing were responsible for training, yet they could not provide a satisfactory explanation for the failure to adhere to the facility's catheter care policy.
Failure to Post Oxygen Use Signage for Residents
Penalty
Summary
The facility failed to ensure that residents requiring respiratory care were provided with appropriate signage indicating oxygen use, as per professional standards and facility policy. Specifically, three residents who were observed using oxygen did not have 'Oxygen in Use' signs posted on their doors. This oversight was noted during observations and interviews, where it was found that the absence of signage could lead to staff and visitors being unaware of the residents' oxygen use. The Assistant Director of Nursing (ADON) and the Director of Nursing (DON) both acknowledged the expectation for such signage and admitted that the failure to post signs was due to staff oversight. Resident #4, a male with severe cognitive impairment, was observed using oxygen without the required signage. Similarly, Resident #13, a female with moderate cognitive impairment, and Resident #17, also with moderate cognitive impairment, were both observed using oxygen without the necessary door signage. The facility's policy, dated February 2024, mandates that 'Oxygen in Use' signs must be placed in resident rooms as needed, highlighting a clear deviation from established protocols. The ADON and DON both recognized the importance of these signs in ensuring that care needs are met and acknowledged their responsibility in monitoring and ensuring compliance with this policy.
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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 Ranger
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Avir At Woodlands | 10.8 mi | ★★★★★ | 15 | 0 |
| Avir At Cisco | 19.1 mi | ★★★★★ | 9 | 0 |
| Villa Haven Health And Rehabilitation Center | 22.6 mi | ★★★★★ | 8 | 0 |
| Deleon Nursing And Rehabilitation | 26.3 mi | ★★★★★ | 5 | 0 |
| Rising Star Nursing Center | 31 mi | ★★★★★ | 4 | 0 |
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