All citations for Onion Creek Nursing and Rehabilitation Center

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Onion Creek Nursing and Rehabilitation Center

Last standard health inspection on record

February 29, 2024

This is more than 2 years ago. Newer inspection results may not be on record yet, so the results below may not describe the home today. Ask the home for its most recent inspection report.

Showing 1 to 25 of 30 citations

  1. Immediate jeopardy to resident health or safety

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Pattern (more than a few residents). CMS level K.

    Health citation F-0686, Quality of Life and Care Deficiencies. Inspection of April 5, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (April 21, 2025).

  2. Immediate jeopardy to resident health or safety

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Isolated (one or a few residents). CMS level J.

    Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of February 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 5, 2025).

  3. Harm to a resident

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Pattern (more than a few residents). CMS level H.

    Health citation F-0684, Quality of Life and Care Deficiencies. Inspection of October 2, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (October 3, 2024).

  4. No harm, with potential for more than minimal harm

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Widespread (many residents). CMS level F.

    Health citation F-0812, Nutrition and Dietary Deficiencies. Inspection of February 29, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 8, 2024).

  5. No harm, with potential for more than minimal harm

    Have generator or other power source capable of supplying service within 10 seconds.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of February 29, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 12, 2024).

  6. No harm, with potential for more than minimal harm

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Widespread (many residents). CMS level F.

    Health citation F-0812, Nutrition and Dietary Deficiencies. Inspection of December 2, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 9, 2022).

  7. No harm, with potential for more than minimal harm

    Have generator or other power source capable of supplying service within 10 seconds.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of September 10, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (October 1, 2021).

  8. No harm, with potential for more than minimal harm

    Ensure that residents are free from significant medication errors.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0760, Pharmacy Service Deficiencies. Inspection of November 5, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (December 12, 2025).

  9. No harm, with potential for more than minimal harm

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0755, Pharmacy Service Deficiencies. Inspection of July 1, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 9, 2024).

  10. No harm, with potential for more than minimal harm

    Ensure that residents are free from significant medication errors.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0760, Pharmacy Service Deficiencies. Inspection of July 1, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 2, 2024).

  11. No harm, with potential for more than minimal harm

    Keep residents' personal and medical records private and confidential.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0583, Resident Rights Deficiencies. Inspection of February 29, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 1, 2024).

  12. No harm, with potential for more than minimal harm

    Provide care and assistance to perform activities of daily living for any resident who is unable.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0677, Quality of Life and Care Deficiencies. Inspection of February 29, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 15, 2024).

  13. No harm, with potential for more than minimal harm

    Ensure medication error rates are not 5 percent or greater.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0759, Pharmacy Service Deficiencies. Inspection of December 2, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 9, 2022).

  14. No harm, with potential for more than minimal harm

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0656, Resident Assessment and Care Planning Deficiencies. Inspection of September 10, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 28, 2021).

  15. No harm, with potential for more than minimal harm

    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0756, Pharmacy Service Deficiencies. Inspection of September 10, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 28, 2021).

  16. No harm, with potential for more than minimal harm

    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0758, Pharmacy Service Deficiencies. Inspection of September 10, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 28, 2021).

  17. No harm, with potential for more than minimal harm

    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0761, Pharmacy Service Deficiencies. Inspection of September 10, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 28, 2021).

  18. No harm, with potential for more than minimal harm

    Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

    Pattern (more than a few residents). CMS level E.

    Fire safety citation K-0222, Egress Deficiencies. Inspection of September 10, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (October 1, 2021).

  19. No harm, with potential for more than minimal harm

    Ensure that residents are free from significant medication errors.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0760, Pharmacy Service Deficiencies. Inspection of June 5, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 16, 2026).

  20. No harm, with potential for more than minimal harm

    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0580, Resident Rights Deficiencies. Inspection of January 28, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 3, 2026).

  21. No harm, with potential for more than minimal harm

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0656, Resident Assessment and Care Planning Deficiencies. Inspection of July 3, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 26, 2025).

  22. No harm, with potential for more than minimal harm

    Assist a resident in gaining access to vision and hearing services.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0685, Quality of Life and Care Deficiencies. Inspection of July 3, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 18, 2025).

  23. No harm, with potential for more than minimal harm

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0609, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of February 19, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 5, 2025).

  24. No harm, with potential for more than minimal harm

    Ensure each resident receives an accurate assessment.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0641, Resident Assessment and Care Planning Deficiencies. Inspection of February 29, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 15, 2024).

  25. No harm, with potential for more than minimal harm

    Provide activities to meet all resident's needs.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0679, Quality of Life and Care Deficiencies. Inspection of February 29, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 29, 2024).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of September 30, 2026. Inspection results describe the home at the time of each inspection.