Facility profile · CCN 175220
Onaga Operator, Llc
23 federal citations on record , including 4 at the Immediate Jeopardy level, and 2 federal enforcement actions totaling $26,429.
Record summary
Federal record · Q1 202623
Total citations
14
Last 3 years
4
Actual harm+
2
Federal penalties
$26,429
Total fines
2
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
23 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Jul 28, 2025 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | J | Complaint |
| Oct 2, 2024 | F880 | Provide and implement an infection prevention and control program. | F | Standard |
| Oct 2, 2024 | 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. | D | Standard |
| Oct 2, 2024 | 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 |
| Oct 2, 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. | D | Standard |
| Oct 2, 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 |
| Oct 2, 2024 | 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 |
| Oct 2, 2024 | F623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | E | Standard |
| Mar 13, 2024 | F760 | Ensure that residents are free from significant medication errors. | J | Complaint |
| Dec 7, 2023 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | L | Complaint |
| Dec 7, 2023 | F604 | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | J | Complaint |
| May 22, 2023 | F690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | Complaint |
| May 22, 2023 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint |
| May 22, 2023 | F580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Complaint |
| Apr 5, 2023 | 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. | D | Complaint |
| Apr 5, 2023 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Complaint |
| Apr 5, 2023 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Apr 5, 2023 | F582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | D | Standard |
| Sep 15, 2021 | F761 | 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. | D | Standard |
| Sep 15, 2021 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Sep 15, 2021 | F686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Standard |
| Sep 15, 2021 | F657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | Standard |
| Sep 15, 2021 | 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. | E | Standard |
Federal enforcement history
Federal regulators have imposed 2 enforcement actions against this facility, including 2 civil money penalties totaling $26,429 .
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| Mar 13, 2024 | Fine | $14,518 | — |
| Dec 7, 2023 | Fine | $11,911 | — |
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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