1920 Rosemont Avenue, Frederick, MD 21702 · Frederick County · (240) 772-9200
170 certified beds, about 159 residents a day · Government - County · Medicare and Medicaid since 1976
CMS Care Compare ratings, data as of September 1, 2026 · CCN 215105 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on March 20, 2026, inspectors cited 8 health deficiencies (the Maryland average is 17, the national average 9.2).
Of 33 health citations since June 2019, 1 was rated as actual harm or immediate jeopardy to residents.
CMS lists no fines against this home in the last three years.
Nurses and nurse aides worked 3.99 hours per resident per day, against 3.87 across Maryland and 3.86 nationally. Registered nurses accounted for 0.77 of those hours.
27.5% of nursing staff left within the year CMS measured (Maryland average 40.2%).
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 33 health citations on file.
Inspectors wroteBased on interviews and record review, it was determined that the facility failed to ensure that residents received their meals at a safe and palatable temperature. This deficient practice has the potential to affect all residents. During an initial tour of the facility on 3/16/26, several residents reported that the facility's food was typically cold for hot foods. A review of the facility's food service temperature logs for January 2026 was conducted on 3/17/26 at 2:02 PM. The review revealed missing internal cooking temperatures for: [...]
Inspectors wroteBased on observation and interviews, it was determined that the facility failed to treat residents with respect and dignity, as evidenced by failing to knock and request permission before entering residents' rooms. This was evident for 1 (Resident #75) of 1 resident reviewed for dignity.
Inspectors wroteBased on interviews and record reviews, it was determined that the facility failed to ensure that residents who required assistance with Activities of Daily Living (ADLs) received showers. This was evident for 1 (Resident #2) of 1 resident reviewed for ADLs.
Inspectors wroteBased on observations, record reviews, and interviews, it was determined that the facility failed to ensure residents with or at risk of developing pressure ulcer/injuries receive appropriate services for treatment and prevention. This was evident for 2 (Resident #10 and #108) of 3 residents reviewed for pressure injuries.
Inspectors wroteBased on observation, medical record review, and interview it was determined that the facility failed to maintain a medication error rate of less than 5%. This was based on 2 errors out of 32 opportunities for error during the medication observation task and involved 2 (Resident #179 and #53) out of the 3 resident's observed.
Inspectors wroteBased on observations, record reviews, and interviews, it was determined that the facility failed to serve residents meals according to a predetermined menu that reflected their preferences. This was evident in 2 out of 3 dining observations during the survey.
Inspectors wroteBased on record review, observation and interviews, it was determined that the facility failed to ensure medical orders were put in correctly and the nurses documented accurate administration of oxygen use. This was evident for 1 (Resident #15) of 5 resident reviewed for respiratory care.
Inspectors wroteBased on record observations, record reviews and interviews, it was determined that the facility failed to ensure staff donned appropriate personal protective equipment (PPE) for residents on enhanced barrier precautions (EBP). This was evident for 2 (Residents #121 and #75) of 7 residents reviewed for infection control and for 1 (Resident #116) of 2 residents reviewed for urinary catheters/UTI.
Inspectors wroteBased on interview and review of facility reported incident (FRI) investigation documentation it was determined the facility failed to thoroughly investigate incidents of missing property, this was evident for 1 (Resident #1) of 2 residents reviewed for facility reported incidents.
Inspectors wroteBased on review of the medical record and interview it was determined the facility staff failed to ensure all prior MOLST forms in the resident record were voided as per the MOLST instructions. This was evident for 1 (#6) of 3 residents reviewed for Quality of Care.
Inspectors wroteBased on observation, interview, and review of the facility policy, the facility failed to ensure all food in the freezer, refrigerator, and dry storage was labeled, dated, and not expired as well as failed to ensure newly washed dishes were allowed to properly air dry and staff wore the appropriate hair coverings. These failures had the potential to affect all 158 residents in the facility who consumed food from the kitchen.
Inspectors wroteBased on observations, interviews, record review and review of facility policy, the facility failed to ensure expired insulin pens were discarded from five medication carts (respiratory care unit (RCU) cart two, second floor long-term care unit (LTC) medication carts one, second-floor LTC medication cart two, third floor LTC medication cart medication cart one, and memory care medication cart one) of nine medication carts reviewed. This failure placed residents at risk of ineffective medication.
Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure infection control measures were appropriately implemented and maintained hand hygiene related to blood glucose testing for four of four residents (Resident (R) 35, R16, R77, and R14) who were observed during testing. Also, the facility failed to ensure wound care was performed in a manner to prevent infection for R115. These failures placed the residents at risk for infections and a decrease in quality of life.
Inspectors wroteBased on interview, record review, and review of the facility policy, the facility failed to ensure a Level II PASARR (a more in-depth preadmission screening and resident review) was obtained, as required for one resident (Resident (R)58) of three sampled residents in a total sample of 39. This failure placed the resident at risk of not receiving specialized services for serious mental illness.
Inspectors wroteBased on record review, interview and facility policy review, the facility failed to develop a comprehensive care plan regarding a condom catheter for one of one resident (Resident (R)155) out of 39 sampled residents. This failure to develop a care plan increased the risk for care to be incomplete and/or inconsistent related to R155 having a condom catheter.
Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to review and revise a comprehensive care plan to reflect the resolution developing of pressure ulcers and non-pressure wounds for one of four residents (Resident (R)155) out of 39 sampled residents. This failure created an increased risk for R155 to receive care and services not appropriate for their current clinical condition.
Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to accurately check the insulin pen that was being used to administer insulin to one of three resident (Resident (R) 14) administered insulin out of six residents being observed during the medication administration task. This failure had the potential for bloodborne pathogens to infect residents by using a reusable insulin pen to a resident other than the resident that it had been ordered for.
Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to ensure that the education of benefits and risks of immunizations for pneumonia and influenza was provided after refusals for the vaccinations for three residents (Residents (R) 36, R20, and R80) of five sampled residents reviewed for immunizations. This failure placed the residents at risk for pneumonia and influenza.
Inspectors wroteBased on medical record review and staff interview, it was determined that facility staff failed to honor a resident' s right to formulate a Do Not Resuscitate (DNR) advance directive and performed CPR (cardiopulmonary resuscitation) against the resident's stated written request. This was evident for 1 of 5 residents (Resident # 43) reviewed for Advance Directives during the survey, and the deficiency was cited to the level of actual harm.
Inspectors wroteBased on medical record review and staff interview, it was determined that the physician failed to review orders for accuracy and failed to write, sign and date medical visit progress notes in resident medical records on the day that the resident was seen. This was evident for 1 (#2) of 11 residents reviewed in final sample and 1 (#6) of 3 residents reviewed for accidents 2 (#8, #9) of 3 residents reviewed.
Inspectors wroteBased on medical record review, a review of facility documentation and staff interview, it was determined that the facility failed to have a system in place to verify that staff had been educated to verify a resident's code status and Maryland Order for Life Sustaining Treatment (MOLST) prior to initiating or not preforming cardiopulmonary resuscitation (CPR).
Inspectors wroteBased on record review and staff interview, it was determined that the facility failed to have a process in place to ensure that Geriatric Nursing Assistance were evaluated every 12 months to ensure competency. This was evident for 2 (#5 and #4) of 3 staff reviewed for competency.
Inspectors wroteBased on observation, resident interview, record review, and staff interview, it was determined that the facility staff failed to maintain accurate records for a resident's respiratory treatments. This was evident for 1 (#2) of 11 residents reviewed for care plans.
Inspectors wroteBased on medical record review and staff interview, it was determined that facility staff failed to ensure that a resident received the assistance of two staff when providing care. This failure resulted in the resident's fall from bed, hematoma and transfer to the emergency room. This was evident for 1 of 5 residents (Resident # 162) reviewed for abuse during the survey.
Inspectors wroteBased on interviews and review of medical records and facility documentation, it was determined that the facility failed to 1). report allegations of abuse to the state survey agency timely and 2). ensure the timely reporting of a staff member's nonadherence to a resident's plan of care. This was found to be evident for 2 out of 8 facility reported incidents (FRI) reviewed during the annual survey regarding Resident # 151 and and Resident #162.
Inspectors wroteBased on administrative record review, medical records review and interviews with facility staff, it was determined that the facility failed to 1). complete a thorough investigation when residents were noted to have an injury of unknown origin and 2). review staff interviews prior to terminating an investigation of a resident's unknown injury 3). implement corrective action to prevent further incidents of allegation of abuse from occurring. This was found to be evident for 4 (R #164, #111, #162 and #151)) of 7 intakes reviewed during the facility's annual Medicare/Medicaid survey.
Inspectors wroteBased on medical record review, and interview with facility staff, it was determined that the facility failed to develop a person-centered individualized comprehensive care plan as evidenced by failure to develop a care plan to address resident activities, for 1 out of 38 (R #8) residents reviewed during the investigation stage of the long-term care survey process.
Inspectors wroteBased on medical record review and interviews with the resident and staff, it was determined that the facility staff failed to 1). follow the interventions on the care plan to prevent skin break down, 2). to ensure that residents and responsible parties (RP) were included in the development and review of a resident's care plan and 3). update a resident's care plan related to reported allegations of sexual misconduct This was true for 3 of 38 (#93, #136 and #151) residents reviewed during the investigative stage of the survey.
Inspectors wroteBased on medical record review, observation and interview with facility staff, it was determined that the facility failed to1) provide activities for an individual based on their assessment, cultural needs, and language/communication and 1a) ensure residents were given an opportunity to attend activities. This was evident for 3 (Resident # 136, # 8 and #126) of 4 residents reviewed for activities in the investigative stage of the survey.
Inspectors wroteBased on administrative record review and interviews with facility staff, it was determined that the facility failed to have a nurse assess a resident when the resident complained of pain during toileting by a GNA. This was found to be evident for 1 (Resident #111) of 6 intakes reviewed during the facility's annual Medicare/Medicaid survey.
Inspectors wroteBased on medical record review and interview with facility staff, it was determined that the facility failed to follow up on a recommendation from the physician for an ophthalmology visit. This was evident during the review of 1 of 38(R#98) resident medical records reviewed during the investigative process.
Inspectors wroteBased on medical record review and staff interview, it was determined the facility staff failed to prevent the development of a pressure ulcers for a functionally impaired resident (Resident #93). This was evident for 2 of 8 residents reviewed for pressure ulcer during the investigative stage of the survey. A pressure ulcer also known as bed sore or decubitus ulcer is any lesion caused by unrelieved pressure or shearing that results in damage to the skin and underlying tissue. Pressure ulcers are staged according to the severity from Stage I (area of persistent redness), Stage II (superficial loss of skin such as an abrasion, blister or shallow crater), Stage III (full thickness skin loss involving damage to subcutaneous tissue presenting as a deep crater) or Stage IV (full thickness skin loss with extensive damage to muscle, bone or tendon). [...]
Inspectors wrote1) a During the initial tour on 6/5/19 at 10:54 AM, surveyor attempted to interview Resident #98 regarding FRI MD00134526. S/he stated that s/he was not feeling that well, but did recall the incident and would like to discuss it further at another time. On 6/7/19 at 8:58 AM, Resident #98's medical record was reviewed. His/her diagnoses included a history of pneumonia, muscle weakness and a need for assistance with personal care. A review of the resident's most recent BIMS showed the resident scored at a 15, (13-15 result is cognitively intact). A review of the FRI noted that, on 12/13/18, Resident #98 reported to the day shift Unit manager that Staff # 7 (from the previous shift) had thrown the call light and hit him/her in the eye. The resident was assessed and noted to have a swollen and red/bruised area to the crease of the right eye. [...]
18 fire safety citations on file: 6 on March 20, 2026, 9 on December 23, 2024, 3 on June 18, 2019.
CMS lists no fines or payment denials against this home in the last three years. The national average is 0.9 fines per home.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Maryland | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.99 | 3.87 | 3.86 |
| Registered nurses | 0.77 | 0.84 | 0.69 |
| All nursing staff on weekends | 3.55 | 3.47 | 3.42 |
| Nurse aides | 2.20 | ||
| Licensed practical nurses | 1.02 | ||
| Nursing staff turnover (share who left in a year) | 27.5% | 40.2% | 45.8% |
| Registered nurse turnover | 23.8% | 38.7% | 42.9% |
| Administrators who left | 0 |
CMS expects 4.02 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 4.17 on weekdays and 3.55 on weekends, 15% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 3.6% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.62 in April to June 2025 to 3.99 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.99 | 0.77 | 4.17 | 3.55 | 3.6% | 0 of 90 | 159 |
| Oct to Dec 2025 | 3.80 | 0.71 | 3.97 | 3.38 | 6.0% | 0 of 92 | 159 |
| Jul to Sep 2025 | 3.50 | 0.59 | 3.67 | 3.07 | 4.1% | 0 of 92 | 155 |
| Apr to Jun 2025 | 3.62 | 0.68 | 3.80 | 3.17 | 0.8% | 0 of 91 | 157 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Maryland, Jan to Mar 2026 | 3.73 | 0.74 | 3.88 | 3.34 | 8.0% | 0.1% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review. If you work here, your report helps start one.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Maryland, all employers | |||
| CNAs (nursing assistants) | $20.79 | $18.46 to $22.00 | 27,720 |
| LPNs and LVNs | $35.89 | $31.40 to $38.30 | 9,560 |
| Registered nurses | $47.98 | $40.26 to $51.61 | 52,910 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Maryland | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 21.9 | 20.4 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.9 | 0.5 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 1.0 | 1.5 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 2.0 | 2.4 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.2 | 1.1 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 18.1 | 22.2 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 3.8 | 5.9 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 7.6 | 13.8 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 17.4 | 21.0 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 6.9 | 9.8 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 0.9 | 1.3 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.6 | 1.2 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Citizens Care and Rehabilitation Center of Frederi's Medicare short-stay residents. On returning residents home or to the community, CMS rates it better than the national rate (64.5% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
64.5% this home
Better than the national rate
US median of homes 51.5% · Maryland: 90 better, 29 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 571 eligible stays.
11.0% this home
No different from the national rate
US median of homes 10.7% · Maryland: 0 better, 41 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 602 eligible stays.
6.3% this home
No different from the national rate
US median of homes 7.1% · Maryland: 5 better, 6 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 352 eligible stays.
73.4% this home
Median of homes: Maryland61.2% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 256 residents counted.
0.8% this home
Median of homes: Maryland0.4% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 357 residents counted.
1.2% this home
Median of homes: Maryland2.4% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 356 residents counted.
98.5% this home
Median of homes: Maryland98.1% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 196 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: FREDERICK COUNTY MARYLAND.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Frederick County Maryland | 5% or greater direct ownership interest | Organization | 09/01/2016 | |
| White, Erin | 5% or greater direct ownership interest | Individual | 11/01/2024 | |
| White, Erin | Corporate director | Individual | 11/01/2024 | |
| Aurora Health Management, LLC | Operational/managerial control | Organization | 09/01/2016 | |
| White, Erin | Operational/managerial control | Individual | 09/01/2016 | |
| Frederick County Maryland | Adp of the SNF | Organization | 02/21/2025 | |
| White, Erin | Adp of the SNF | Individual | 11/01/2024 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
These are the official offices in Maryland. NursingHomeClear cannot take or act on complaints.