Facility profile · CCN 555235
Ahmc Seton Medical Center
61 federal citations on record , and 6 federal enforcement actions totaling $48,836.
Record summary
Federal record · Q1 202661
Total citations
33
Last 3 years
7
Actual harm+
6
Federal penalties
$48,836
Total fines
1
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
61 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Aug 15, 2025 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint |
| Aug 15, 2025 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint |
| Aug 15, 2025 | F584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | D | Complaint |
| Aug 15, 2025 | F880 | Provide and implement an infection prevention and control program. | D | Standard |
| Aug 15, 2025 | F867 | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | F | Standard |
| Aug 15, 2025 | F865 | Have a plan that describes the process for conducting QAPI and QAA activities. | F | Standard |
| Aug 15, 2025 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard |
| Aug 15, 2025 | F801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | F | Standard |
| Aug 15, 2025 | F692 | Provide enough food/fluids to maintain a resident's health. | D | Standard |
| Aug 15, 2025 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard |
| Aug 15, 2025 | F641 | Ensure each resident receives an accurate assessment. | D | Standard |
| Aug 15, 2025 | F637 | Assess the resident when there is a significant change in condition | D | Standard |
| Aug 15, 2025 | F610 | Respond appropriately to all alleged violations. | D | Standard |
| Aug 15, 2025 | F578 | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | D | Standard |
| May 16, 2025 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint |
| May 8, 2025 | F628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | D | Complaint |
| Apr 18, 2025 | F585 | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | D | Complaint |
| Feb 14, 2024 | F924 | Put firmly secured handrails on each side of hallways. | D | Standard |
| Feb 14, 2024 | F920 | Provide at least one room set aside to use as a resident dining room and for activities, that is a good size, with good lighting, air flow and furniture. | E | Standard |
| Feb 14, 2024 | F908 | Keep all essential equipment working safely. | D | Standard |
| Feb 14, 2024 | F887 | Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | D | Standard |
| Feb 14, 2024 | F883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | Standard |
| Feb 14, 2024 | F842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Standard |
| Feb 14, 2024 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard |
| Feb 14, 2024 | F758 | 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. | G | Standard |
| Feb 14, 2024 | F756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | Standard |
| Feb 14, 2024 | F688 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | E | Standard |
| Feb 14, 2024 | F686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | Standard |
| Feb 14, 2024 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | Standard |
| Feb 14, 2024 | F641 | Ensure each resident receives an accurate assessment. | E | Standard |
| Feb 14, 2024 | F585 | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | E | Standard |
| Feb 14, 2024 | F584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | D | Standard |
| Feb 14, 2024 | F557 | Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | E | Standard |
| Feb 15, 2022 | F919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | F | Standard |
| Feb 15, 2022 | F908 | Keep all essential equipment working safely. | E | Standard |
| Feb 15, 2022 | F888 | Ensure staff are vaccinated for COVID-19 | D | Standard |
| Feb 15, 2022 | F883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | Standard |
| Feb 15, 2022 | F880 | Provide and implement an infection prevention and control program. | E | Standard |
| Feb 15, 2022 | F867 | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | E | Standard |
| Feb 15, 2022 | F838 | Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. | F | Standard |
| Feb 15, 2022 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard |
| Feb 15, 2022 | F804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | D | Standard |
| Feb 15, 2022 | F803 | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | E | Standard |
| Feb 15, 2022 | F802 | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | E | Standard |
| Feb 15, 2022 | F801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | E | Standard |
| Feb 15, 2022 | F759 | Ensure medication error rates are not 5 percent or greater. | E | Standard |
| Feb 15, 2022 | F755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard |
| Feb 15, 2022 | F726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | F | Standard |
| Feb 15, 2022 | F692 | Provide enough food/fluids to maintain a resident's health. | D | Standard |
| Feb 15, 2022 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Feb 15, 2022 | F688 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | G | Standard |
| Feb 15, 2022 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | Standard |
| Feb 15, 2022 | F658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | Standard |
| Feb 15, 2022 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | Standard |
| Feb 15, 2022 | F655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D | Standard |
| Feb 15, 2022 | F641 | Ensure each resident receives an accurate assessment. | D | Standard |
| Feb 15, 2022 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Standard |
| Feb 15, 2022 | F607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | Standard |
| Feb 15, 2022 | F584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | H | Standard |
| Feb 15, 2022 | F558 | Reasonably accommodate the needs and preferences of each resident. | D | Standard |
| Feb 15, 2022 | F550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | E | Standard |
Federal enforcement history
Federal regulators have imposed 6 enforcement actions against this facility, including 3 civil money penalties totaling $48,836 and 3 payment-denial actions spanning 177 days.
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| Aug 15, 2025 | Fine | $22,335 | — |
| Aug 15, 2025 | Payment Denial | — | Sep 13, 2025 · 132 days |
| Apr 18, 2025 | Fine | $12,438 | — |
| Apr 18, 2025 | Payment Denial | — | Jun 5, 2025 · 15 days |
| Feb 14, 2024 | Fine | $14,063 | — |
| Feb 14, 2024 | Payment Denial | — | Mar 21, 2024 · 30 days |
About this record
A citation is a finding by a state survey team working under federal contract. It is not a court
judgment. The description above is drawn verbatim from federal public datasets. Facilities have
the right to appeal findings through an Informal Dispute Resolution (IDR/IIDR) process.
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