Above average — CMS composite of the measures below.
The next survey window likely opens around October 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Americana Health And Rehabilitation during CMS and state inspections, most recent first.
Several residents did not receive timely bowel interventions as ordered, with staff failing to administer or document required steps such as laxatives, suppositories, or enemas after multiple days without a bowel movement. Staff interviews confirmed that the bowel management protocol was not consistently followed or documented, resulting in prolonged periods without appropriate care.
Surveyors found that two residents receiving IV therapy did not have their PICC lines properly assessed or monitored according to facility policy and professional standards. Orders were incomplete, lacking details such as PICC type and required monitoring, and documentation was missing for key assessments like external length and arm circumference measurements, as well as for needleless cap changes and daily site checks. The DON confirmed these deficiencies in documentation and order completeness.
A resident's trust account balance was not transferred to the Office of Financial Recovery within the required 30-day period following the resident's death. The funds remained in the facility's account for several months before being conveyed, as confirmed by the Business Office Manager.
A resident's bed was placed against the wall, constituting a potential physical restraint, without a documented Safety Device Evaluation, consent, or physician's order. The resident, who was moderately cognitively impaired, reported no discussion about the bed placement. Staff interviews confirmed that required documentation and consent were missing, in violation of facility policy.
A resident's admission MDS assessment was not completed within the required 14-day timeframe, with the assessment being finalized 20 days after admission. The MDS Coordinator confirmed the delay during an interview, and records supported the finding.
Two residents had inaccurate MDS assessments: one with a terminal diagnosis receiving hospice care was not coded as having a terminal prognosis, and another's frequency of care refusals was underreported compared to medication and meal records. The MDS Coordinator confirmed both assessments were inaccurate.
Care plans for three residents were not updated to include treatment for an anal fissure, constipation, or the presence and management of PICC lines for IV therapy. The DON confirmed that these care needs should have been addressed in the care plans.
Nursing staff did not consistently follow or clarify physician orders for three residents, including failing to notify providers of significant weight changes, improperly holding prescribed medication despite vital signs being within parameters, and not clarifying PICC line flush orders. These actions resulted in incomplete documentation and lack of required provider notifications.
A resident assessed to need a passive ROM Restorative Nursing Program (RNP) five times weekly received the intervention only about once per week over a 52-day period, far less than prescribed. The DON confirmed the RNP was not provided at the required frequency.
The facility failed to label and date food items in the kitchen and nourishment refrigerators, leading to the disposal of undated and expired items. The Dietary Manager and Director of Nursing acknowledged the oversight, which included unlabeled celery and carrot sticks, expired pumpkin pie, cake, sour cream, and other items. This failure to adhere to facility policy posed a risk to resident safety.
The facility failed to label medications with the date first accessed in two medication storage areas and did not secure medications for a resident. Multi-dose vials of insulin and a TB test solution were found without access dates, and a resident's medications were left unsecured on a bedside table. Staff acknowledged the need to discard undated medications and ensure medication security.
A resident, who was moderately cognitively impaired, received an influenza vaccination without a signed consent from the resident or their representative. The facility's policy requires documentation of consent or declination in the EHR, but a review showed no signed consent. Staff confirmed the absence of consent, acknowledging that it should have been obtained yearly before vaccination.
A facility failed to ensure residents were free from physical restraints, as a resident's bed was repeatedly observed against the wall, potentially restricting movement. Staff acknowledged the need for consent and care plan inclusion, but these were not in place. The DON confirmed the bed should not have been positioned against the wall, highlighting a lapse in monitoring and adherence to care plans.
A facility failed to develop a comprehensive care plan for a resident on Apixaban, an anticoagulant, for paroxysmal atrial fibrillation. The care plan lacked documentation for monitoring side effects, despite facility policy requiring such monitoring. The resident was observed with discoloration of the lower extremities, a potential side effect, but staff could not provide documentation of a care plan addressing anticoagulant therapy and side effect monitoring.
A facility failed to initiate bowel interventions for a resident who did not have a bowel movement for over four days on two occasions. The facility's bowel protocol requires intervention after three days without a bowel movement, but records showed no such actions were taken. Staff interviews confirmed the oversight, with the LPN acknowledging the resident should have been on the list for interventions, and the DON unable to provide documentation of any actions taken.
A facility failed to implement Enhanced Barrier Precautions (EBP) for a resident with a chronic wound, as required by CMS guidelines. Despite the resident having a right heel wound needing daily dressing changes, no EBP signage or PPE was observed. The Infection Preventionist stated EBP was unnecessary due to the lack of drainage, contradicting CMS recommendations. A nurse confirmed using only gloves during wound care, increasing the risk of infection transmission.
A resident with moderate persistent asthma experienced respiratory failure due to the facility's failure to notify the physician of significant respiratory changes and obtain necessary medications. Despite administering oxygen and other treatments, the facility did not document physician notification or orders, leading to the resident's hospitalization and intubation.
Failure to Initiate and Document Bowel Interventions per Physician Orders
Penalty
Summary
The facility failed to initiate and document bowel interventions as ordered for five residents who were reviewed for quality of care. According to the facility's bowel protocol and physician orders, licensed nurses were required to monitor bowel movements daily and administer specific interventions if a resident had not had a bowel movement for three days. These interventions included administering milk of magnesia on day four, followed by a stimulant laxative suppository or oral tablet if there was no result, then an enema if still no result, and notifying the physician if all interventions failed. However, record reviews showed that these steps were not followed for multiple residents. For example, one resident went approximately 139 hours without a bowel movement, and another went about 228 hours, with no documentation of any bowel interventions during these periods. Another resident experienced a gap of 110 hours between bowel movements, again with no evidence of interventions being administered as per protocol. Additionally, a resident reported experiencing constipation and hard stools, with records confirming that staff did not administer the required interventions on the fourth day without a bowel movement. In another case, a resident went seven days without a bowel movement, and although some interventions were attempted, staff failed to follow through with the full protocol as ordered. Interviews with staff, including the Resident Care Manager, LPN, and DON, confirmed that the bowel management protocol was not consistently followed or documented. Staff acknowledged that alerts should have triggered interventions and that the protocol should have been initiated and documented per policy. However, they were unable to provide documentation of successful bowel interventions for the affected residents during the periods in question.
Failure to Properly Assess and Monitor IV Access Devices
Penalty
Summary
The facility failed to ensure that intravenous (IV) access devices were assessed, maintained, and monitored according to professional standards of practice for two residents who were receiving IV therapy. The facility's policy required staff to measure the external length of a Peripherally Inserted Central Catheter (PICC) and the resident's arm circumference upon admission or insertion, and then weekly with dressing changes. However, for both residents reviewed, there was no documentation that these measurements were obtained at admission or during their stay. Additionally, staff did not consistently document the changing of needleless injection caps with dressing changes or daily assessment of the PICC insertion site for signs of complications. For one resident with diagnoses of intervertebral discitis and osteomyelitis who was receiving IV antibiotics, physician orders for PICC maintenance and monitoring were incomplete. The orders did not specify whether the PICC was valved or non-valved, the number of lumens, or the location of the line, and directed staff to use a flush protocol that was inconsistent with facility policy. The resident's care plan did not address the type, location, or required maintenance and monitoring of the PICC. Medication and treatment administration records indicated that staff signed off on daily flushing of the PICC, but it was unclear which protocol was followed, and there was no documentation of required cap changes or site assessments. For another resident with a diagnosis of left lower extremity cellulitis who was also receiving IV antibiotics, physician orders similarly lacked direction for daily monitoring of the PICC insertion site and did not require measurement of the PICC external length upon admission or weekly. The orders also failed to specify whether the PICC was valved or non-valved and the number of lumens. Documentation showed that staff signed for dressing changes and arm circumference measurements, but there was no place to record the actual measurements, and no documentation was found that these assessments were performed. The Director of Nursing Services confirmed the lack of documentation and incomplete orders for both residents.
Delayed Conveyance of Resident Funds After Death
Penalty
Summary
The facility failed to ensure that resident funds were conveyed to the Office of Financial Recovery (OFR) within 30 days of a resident's death or discharge, as required. Specifically, review of records showed that a resident was transferred to the hospital and subsequently passed away on the same day. Despite this, the resident's trust account balance of $60 remained in the facility's account from March through August, and was not conveyed to the OFR until several months after the resident's death. During an interview, the Business Office Manager confirmed that the funds were not transferred within the required timeframe.
Failure to Obtain Consent and Evaluation for Bed Placement as a Physical Restraint
Penalty
Summary
The facility failed to obtain a Safety Device Evaluation, consent, and/or a physician's order for the use of a physical restraint for one resident. Specifically, the resident's bed was positioned with the right side against the wall, which is considered a potential restraint. There was no documentation in the resident's electronic health record of an evaluation, consent, or physician's order related to this bed placement. The resident, who was moderately cognitively impaired according to the most recent assessment, stated that her bed had always been positioned this way and that no one had discussed the reason for it with her. Interviews with facility staff, including an LPN and the DON, confirmed that facility policy requires resident consent and an evaluation before implementing any type of restraint or safety device. Both staff members were unable to locate any documentation or consent for the bed placement for this resident. The facility's policy also requires that the care plan be updated and evaluated regularly for device use, but there was no evidence that these steps were followed in this case.
Late Completion of Admission MDS Assessment
Penalty
Summary
The facility failed to complete the admission Minimum Data Set (MDS) assessment within the required 14 days for one resident. Specifically, a review of records showed that the resident was admitted on a certain date, but the admission MDS was not completed until 20 days after admission, exceeding the regulatory timeframe. During an interview, the MDS Coordinator confirmed that the assessment was not completed by the 14th calendar day as required. This deficiency was identified through both interview and record review, and it was noted that such delays could place residents at risk for unidentified or unmet care needs.
Inaccurate Resident Assessments Documented in MDS
Penalty
Summary
The facility failed to ensure that resident assessments accurately reflected the health status and care needs of two residents. For one resident with a terminal diagnosis of severe COPD, respiratory failure, and hypoxia, hospice intake paperwork and ongoing hospice documentation confirmed a life expectancy of less than six months and continuous hospice services. However, multiple Quarterly Minimum Data Set (MDS) assessments did not indicate the resident's terminal prognosis, despite the resident remaining on hospice care throughout the period. The MDS Coordinator confirmed that these assessments were inaccurate and should have reflected the terminal prognosis. For another resident, the Quarterly MDS assessment documented that the resident rejected care on 1-3 days during the assessment period. However, a review of the Medication Administration Record and meal monitor showed that the resident refused medications and alternative meals on five of seven days during the same period. The MDS Coordinator acknowledged that the MDS was inaccurate and required modification to reflect the correct frequency of care rejection. These inaccuracies in resident assessments were identified through interviews and record reviews.
Care Plans Not Updated to Reflect Residents' Clinical Needs
Penalty
Summary
The facility failed to ensure that care plans were reviewed, revised, and accurately reflected the care needs of three residents. For one resident, there was an order to cleanse and treat an anal fissure, but the comprehensive care plan did not address this condition. Additionally, this resident was noted to be constipated according to the Minimum Data Set, but no care plan was developed or implemented for constipation. The Director of Nursing Services acknowledged that both the anal fissure and constipation should have been included in the care plan but were not. Another resident was admitted with a peripherally inserted central catheter (PICC) and an order for intravenous antibiotics due to septic arthritis and spondylodiscitis, but the care plan did not address the type, location, number of lumens, or maintenance and monitoring instructions for the PICC. Similarly, a third resident had a PICC for IV infusions to treat muscle calcification, but the care plan lacked documentation regarding the PICC's type, location, number of lumens, and maintenance and monitoring instructions. In each case, the DON confirmed that these aspects should have been included in the residents' care plans.
Failure to Follow and Clarify Physician Orders and Notify Providers
Penalty
Summary
Nursing staff failed to follow and/or clarify physician orders and did not notify providers as required for three residents. For one resident, daily weights were ordered, but significant weight variances exceeding three pounds in 24 hours were not reported to the provider on multiple occasions, and there was no documentation of such notifications. Another resident had an order for metoprolol with specific parameters for holding the medication and notifying the physician; however, staff held the medication multiple times when the resident's vital signs were within the ordered parameters, and did not notify the physician as required. Additionally, this resident experienced a weight loss of 5.8 pounds in 24 hours, but there was no documentation that the physician was notified as ordered. For a third resident, there was an order to flush a PICC line with normal saline and, if non-valved, with heparin. The order was transcribed without specifying whether the PICC was valved or non-valved, making it unclear if the appropriate flushes, including heparin, were administered. The DON confirmed that the documentation did not clarify this and that staff did not seek clarification of the order.
Failure to Provide Prescribed Passive ROM Program
Penalty
Summary
The facility failed to ensure that a resident with limited range of motion (ROM) received the prescribed treatment and services to maintain or improve ROM. The resident, who was cognitively intact, was assessed to require a passive ROM Restorative Nursing Program (RNP) to both lower extremities, consisting of two sets of 15 repetitions (hip flexion, hip abduction, heel sliders, and ankle pumps) five times a week. However, review of restorative flowsheets showed that over a 52-day period, the passive ROM RNP was only offered or provided on eight out of 36 scheduled days, averaging approximately 1.1 times per week, which was significantly less than the care plan required. The Director of Nursing Services confirmed that the RNP was not provided at the assessed frequency.
Failure to Label and Date Food Items in Refrigerators
Penalty
Summary
The facility failed to ensure proper labeling and dating of food items in both the kitchen and nourishment refrigerators, as observed during a survey. In the kitchen walk-in refrigerator, undated and unlabeled items such as a plastic bag of celery sticks, a plastic bag of carrot sticks with a received date, and a cardboard box containing rosemary were found. The Dietary Manager, Staff N, acknowledged that these items should have been dated and was unable to determine how long they had been stored. Consequently, these items were discarded as they were deemed unsafe for consumption. In the nourishment refrigerator/freezer located in the central supply room, several items were found to be undated or expired, including a pumpkin pie, a quarter sheet of cake, a jar of sour cream, a plastic container of coffee creamer with an illegible expiration date, a partially consumed ice cream shake, and a ziplock bag containing unknown food items. Staff N confirmed that it was the responsibility of the kitchen staff to manage the items in the fridge and admitted that the items in question were not safe to consume, leading to their disposal. The Director of Nursing Services, Staff B, stated that she expected all food items to be dated and labeled according to facility policy.
Medication Labeling and Security Deficiencies
Penalty
Summary
The facility failed to properly label medications with the date they were first accessed in two of three medication storage areas, specifically in the Ocean Side medication storage room and medication cart. During an observation, a multi-dose vial of purified protein derivative used for TB skin tests was found in the medication refrigerator without a date indicating when it was first accessed. Additionally, two multi-dose vials of insulin, Humulin and Lispro, were observed on the medication cart without dates showing when they were first accessed. Staff members acknowledged that medications without open dates should be discarded to prevent administering potentially unsafe medications. Furthermore, the facility did not ensure the security of medications for a resident, as observed when a medicine cup containing various pills was left on the resident's bedside table while she was eating breakfast. The Resident Care Manager and LPN stated that the nurse should have remained with the resident until all medications were ingested or secured them if the resident was not ready to take them. The Director of Nursing Services confirmed that it was expected that nurses do not administer medications without a date showing when they were first accessed and that such medications should be discarded.
Failure to Obtain Consent for Influenza Vaccination
Penalty
Summary
The facility failed to ensure that residents and/or their representatives were informed and provided consent before administering an influenza vaccination. This deficiency was identified for one of the five sampled residents reviewed for the right to be informed to make treatment decisions. Specifically, Resident 24, who was moderately cognitively impaired, received an influenza vaccination on 10/04/2024 without a signed consent from the resident or the resident's representative. The facility's policy, updated on 01/04/2023, requires documentation in the Electronic Health Record (EHR) of consent or declination for each resident. However, a review of Resident 24's EHR showed no signed consent for the vaccination. Staff C, an Infection Preventionist and RN, confirmed the absence of a signed consent, and Staff B, the Director of Nursing Services and RN, acknowledged that a consent should have been signed yearly before administering the influenza vaccination.
Failure to Ensure Residents are Free from Physical Restraints
Penalty
Summary
The facility failed to ensure that residents were free from physical restraints, as evidenced by the case of Resident 19. Resident 19, who was moderately cognitively impaired, was observed multiple times with their bed positioned against the wall, which could potentially restrict movement. Staff K, an MDS Coordinator and RN, acknowledged that such a setup should have a consent, an order, and be part of the care plan. However, Staff E, a Resident Care Manager and LPN, admitted that there was no consent found, and it was not included in the care plan. Furthermore, Staff B, the Director of Nursing Services, confirmed that Resident 19's bed was not supposed to be against the wall and emphasized that staff should monitor bed placements and adhere to the care plan. This oversight placed residents at risk for injury and decreased quality of life.
Failure to Develop Comprehensive Care Plan for Anticoagulant Monitoring
Penalty
Summary
The facility failed to develop a comprehensive care plan for monitoring the side effects of anticoagulant therapy for Resident 150, who was on Apixaban for paroxysmal atrial fibrillation. Despite the facility's policy requiring monitoring for complications from anticoagulant medications, Resident 150's care plan, dated 11/21/2024, did not include documentation for anticoagulant therapy or side effect monitoring. Additionally, the electronic health record lacked orders addressing anticoagulant side effect monitoring. On 12/12/2024, Resident 150 was observed with significant discoloration of the lower extremities, a potential side effect of anticoagulant therapy, but the resident was unable to provide further information. Staff M, an LPN, confirmed that residents on anticoagulants were monitored daily for issues like bruising and bleeding, and that such monitoring should be part of the care plan. However, Staff M and Staff B, the Director of Nursing Services, were unable to provide documentation of a care plan for anticoagulant therapy and side effect monitoring for Resident 150.
Failure to Initiate Bowel Protocol for Resident
Penalty
Summary
The facility failed to initiate bowel interventions for a resident, identified as Resident 35, who was reviewed for quality of care related to constipation. According to the facility's bowel protocol, if a resident does not have a bowel movement for three days, the nurse is required to administer the physician-ordered bowel program. In the absence of a specific bowel program, the protocol dictates the administration of Milk of Magnesia on the fourth day, followed by a stimulant laxative suppository if there are no results, and an enema if necessary, with physician notification if there is still no result. However, the records for December 2024 showed that Resident 35 did not have a bowel movement for over four days on two separate occasions, yet the bowel protocol was not initiated as required. Interviews with staff revealed that the Licensed Practical Nurse, Staff M, acknowledged the oversight, stating that Resident 35 should have been on the list for bowel interventions and had not been given Milk of Magnesia since September. The Director of Nursing Services, Staff B, confirmed that the bowel protocol should have been initiated according to the facility's policy but was unable to provide documentation showing that the necessary interventions were carried out for Resident 35. This failure to follow the bowel protocol placed the resident at risk for discomfort and health complications.
Failure to Implement Enhanced Barrier Precautions During Wound Care
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions (EBP) during wound care for a resident, identified as Resident 33, who was reviewed for infection prevention and control. According to the Centers for Medicare and Medicaid Services (CMS) Memorandum, EBP should be employed for residents with chronic wounds or indwelling medical devices during high-contact care activities, regardless of their multidrug-resistant organism status. Resident 33 had a right heel wound that required daily dressing changes, yet there was no EBP signage or personal protective equipment (PPE) observed on the resident's door or room entrance during multiple observations. Staff C, the Infection Preventionist and Registered Nurse, stated that if wounds are contained, residents do not necessarily require precautions, and since Resident 33's wound did not have drainage, EBP was deemed unnecessary. However, this contradicts the CMS guidelines that recommend EBP for residents with open wounds. Staff G, a Licensed Practical Nurse, confirmed changing the dressing without using additional PPE beyond gloves. This oversight in implementing EBP placed residents at risk for contracting infectious diseases and decreased their quality of life.
Failure to Notify Physician of Respiratory Changes
Penalty
Summary
The facility failed to ensure timely physician consultation and notification regarding a significant change in a resident's respiratory status, which led to harm. A resident with a history of moderate persistent asthma and status asthmaticus experienced respiratory failure requiring hospitalization and intubation. The facility did not notify the physician of the need for oxygen administration orders or obtain necessary seasonal allergy and asthma medications in a timely manner. The resident was admitted with diagnoses including moderate persistent asthma and was alert and oriented. Despite experiencing respiratory symptoms such as shortness of breath and wheezing, the facility did not document physician notification after administering medications like Albuterol and Guaifenesin. The resident's oxygen saturation levels were below normal, and although oxygen was administered, there was no documentation of physician notification or orders for oxygen administration. Staff interviews revealed a lack of clarity and follow-through in the process of obtaining physician orders and addressing the resident's respiratory symptoms. The resident requested an Advair inhaler, which was not provided due to an expired medication and lack of response from the physician. The resident was eventually found unresponsive with critically low oxygen saturation levels, leading to emergency hospitalization.
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Illustrative
What surveyors actually found near you
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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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Illustrative
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Nursing homes near Longview
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Frontier Rehabilitation And Extended Care | 0.7 mi | ★★★★★ | 21 | 0 |
| Beacon Hill Rehabilitation | 3.1 mi | ★★★★★ | 9 | 0 |
| Woodland Convalescent Center | 18 mi | ★★★★★ | 2 | 0 |
| Saint Helens Post Acute | 19.3 mi | ★★★★★ | 36 | 0 |
| Avalon Care Center - Scappoose | 25.9 mi | ★★★★★ | 16 | 0 |
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