Health inspections
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.
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
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 9 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
0G
0H
0I
Potential for more than minimal harm
8D
1E
0F
Potential for minimal harm
0A
0B
0C
November 18, 2025Standard inspection · 1 citation
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on policy review, record review, and interview the facility failed to revise a care plan for 1 of 20 (Resident #90) sampled residents reviewed.
July 25, 2024Standard inspection · 3 citations
- D
Provide and implement an infection prevention and control program.
Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure proper infection control practices were followed during medication administration when 2 of 4 Licensed Practical Nurses (LPN A, and B) failed to perform proper hand hygiene and failed to allow proper drying time for the use of the blood glucose (machine used to measure sugar in the blood) meter after use, and when 1 of 2 (LPN D) failed to clean the enteral feeding syringe (plastic syringe used to give medications or feeding supplements to residents through a plastic tube connected to the stomach) after use, and when Certified Nurse Assistant (CNA P) failed to wear Protective Protection Equipment (PPE) while providing care to a resident on contact isolation.
- D
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure a safe, sanitary, and comfortable environment for Resident #65 for 1 of as evidenced by a dirty bedpan was observed on the bathroom counter next to open toiletries.
- D
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Inspectors wroteBased on review of the Certified Nursing Assistant (CNA) staff in-services, and interview the facility failed to ensure the mandatory annual 12 hours of CNA in-services were provided for 15 of 19 staff members (CNAs A, B, C, D, E, F, G, H, I, J, K, L, M, N, and O reviewed for CNA in-servicing training.
April 5, 2023Standard inspection · 5 citations
- E
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.
Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications were properly stored and secured when 1 of 4 staff members (Licensed Practical Nurse (LPN) #1) left the medication cart unlocked, unattended, and out of sight, and when in 7 of 18 medication storage areas (South Wing Medication Room, South Wing Medication Cart #2, [NAME] Wing #1 Medication Room, East Wing Clean Utility Room, [NAME] Wing #1 Treatment Cart, [NAME] Wing #2 Storage Room and South Wing Treatment Cart) had expired medications, open and undated medications, and externals and internals stored together in the medication storage areas, and when a medication left at the bedside in a resident's room.
- D
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Inspectors wroteBased on policy review, observation, and interview, the facility failed to maintain or enhance resident dignity and respect when 2 of 12 (Certified Nursing Assistant) (CNA) #1, and Licensed Practical Nurse (LPN) #1, staff members observed during dining failed to use courtesy titles to address residents.
- D
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.
Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to provide information regarding a resident's right to formulate an advance directive for 1 of 16 sampled residents (Resident #15) reviewed for advance directives.
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on medical record review and interview, the facility failed to ensure 4 of 16 sampled residents (Resident #21, #25, #34 and #35) or their families were invited to participate in planning their care.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on policy review, medical record review, observation, and interview the facility failed to follow physician's order for 1 of 1 (Resident #364) sample residents reviewed for falls.
Fire safety inspections
4 fire safety citations on file: 1 on November 18, 2025, 3 on July 25, 2024.
Every fire safety citation4 citations
- D
Have properly located and lighted "Exit" signs.
K 293 · November 18, 2025 · Corrected (the home has a date of correction)
- D
Have approved installation, maintenance and testing program for fire alarm systems.
K 345 · July 25, 2024 · Corrected (the home has a date of correction)
- D
Have generator or other power source capable of supplying service within 10 seconds.
K 918 · July 25, 2024 · Corrected (the home has a date of correction)
- D
Have proper medical gas storage and administration areas.
K 923 · July 25, 2024 · Corrected (the home has a date of correction)