Christ the King Manor.

“Resident with documented aggression care plan was involved in a physical confrontation with two other residents on the Alzheimer Unit, striking one resident multiple times in the neck and head area and pushing another, causing both to fall and sustain injuries requiring emergency room evaluation. This was a repeat violation.”

“Three residents on the Alzheimer Unit were involved in a physical altercation resulting in two residents sustaining significant injuries including contusions, skin tears, and pain, requiring emergency hospital transport and evaluation.”

“Multiple common areas of the home, including the dining area, were being video recorded without signage indicating that video recording was in progress.”

“A resident's medication administration on a specific date in December 2025 was not documented on the Medication Administration Record for the corresponding date.”

“The home failed to notify the prescribing physician within 24 hours of medication refusals by residents, including refusals of anxiety medication on multiple dates and refusals of other medications on multiple dates.”

“Resident #1's prescribed boric acid/cornstarch medication was stored in the resident's bedroom instead of being offered by staff at prescribed times as indicated in the support plan. The July 2025 medication administration record contained no documentation of offering this medication to the resident.”

“Staff person A wrote out 3 checks from resident #1's checking account and forged the resident's signature. Bank documentation confirmed these checks were deposited via mobile deposit to staff person A's bank account. This constitutes financial abuse and neglect of the resident.”

“On 7/1/25 at 12:00 p.m., the lid to the garbage can was pushed to the side and garbage was on the floor of the men's common bathroom by the administrative offices, creating a potential for insect and rodent penetration.”

“On 7/1/25 at 12:15 p.m., there was an approximate 5' X 2' puddle of water on the floor in the mechanical room between personal care and the secure dementia care unit, creating a hazard and safety concern.”

“On 7/1/25 at 11:30 a.m., emergency telephone numbers, including the nearest hospital and fire department, were not posted on or by the telephone in the personal care kitchenette.”

“On 7/1/25 at 11:50 a.m., there was an unlabeled bar of soap in the community shower room of the secure dementia care unit. Facility policy requires that bar soap be clearly labeled for each resident who shares a bathroom or liquid soap dispensers be used.”

“Resident #4's support plan was not updated to address the resident's exit-seeking behaviors, aggression toward residents and staff, and the resident's statement of wanting to die.”

“Resident #1 in bedroom did not have access to a source of light that could be turned on/off at bedside; the bedside lamp was approximately 5 feet from the bed. This was a repeat violation from 3/14/23.”

“A dented 4-pound, 2.5 ounce can of tuna was found in the pantry.”

“The home served 54 residents but had no emergency food supply and does not have a contract with a food supplier to provide support in the event of an emergency.”

“Resident #5, prescribed a diabetic, dysphagia texture diet requiring ground meats and small pieces, was served a whole, unaltered slice of pizza at approximately 12:00 pm.”

“Dimetapp Cold and Cough Solution prescribed for resident #3 was in the medication cart; however, the medication was discontinued on 2/20/24.”

“Resident #3's Loperamide HCI pharmacy label indicated '1 cap three times a day for 14 days' rather than the prescribed '1 cap three times a day as needed for diarrhea.'”

“Resident #2 and #3's assessments did not address the resident's need for an enabler, the intended use and risks associated with the device, resident's ability to use the device safely, and whether a cover is required.”

“The home failed to report an incident to the Department within 24 hours. A resident sustained an unwitnessed fall in their bedroom resulting in a broken/bloody nose, multiple abrasions, and a deep tree-shaped abrasion on the right knee. The resident was hospitalized but the facility did not report the incident to the Department as required.”