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 15 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
1K
0L
Actual harm
1G
0H
0I
Potential for more than minimal harm
13D
0E
0F
Potential for minimal harm
0A
0B
0C
February 26, 2026Complaint inspection · 1 citation
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Inspectors wroteBased on medical record review, staff interview, state survey agency incident database review, and policy and procedure review, the facility failed to accurately and timely report allegations of abuse for 1 of 13 sample residents (#1) reviewed for reportable allegations.
November 20, 2025Standard inspection · 3 citations
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, staff interview, medical record review, and manufacturer's instruction review, the facility failed to ensure appropriate use of mechanical lifts during 1 random observation of mechanical lift transfers for a sample resident #3.
- D
Ensure that residents are free from significant medication errors.
Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure residents were free from significant medication errors for 1 of 11 sampled residents (#40).
- D
Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, staff interview, and review of policy and procedures, the facility failed to ensure effective infection prevention practices were implemented during one random observation of linen transportation.
October 23, 2025Complaint inspection · 2 citations
- D
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Inspectors wroteBased on medical record review, staff interview, and policy and procedure review, the facility failed to ensure physician notification of a resident change in condition for 1 of 4 sample residents (#1) reviewed for a change of condition.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on medical record review, staff interview, and policy and procedure review, the facility failed to ensure residents receive quality of care and treatment to meet the resident's mental, physical, and psychosocial needs for 1 of 4 sample residents (#1) reviewed for diabetic treatment.
July 7, 2025Complaint inspection · 2 citations
- D
Ensure services provided by the nursing facility meet professional standards of quality.
Inspectors wroteBased on record review, resident representative and staff interview and policy and procedure review, the facility failed to meet professional standards of quality for 1 of 3 sample residents (#1) reviewed for diagnostic service orders.
- D
Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them.
Inspectors wroteBased on record review, resident representative and staff interview, and policy and procedure review, the facility failed to meet the needs of residents with regard to the quality and/or timeliness of providing radiology or other diagnostic services for 1 of 3 sample residents (#1) reviewed for diagnostic service orders.
June 27, 2024Standard inspection · 1 citation
- D
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Inspectors wroteBased on medical record review, staff interview, and review of facility policies and CDC immunization recommendations, the facility failed to ensure residents were offered pneumococcal immunizations based on CDC recommendations for 1 of 5 sample residents (#11) reviewed for immunizations.
March 6, 2024Complaint inspection · 2 citations
- K
Respond appropriately to all alleged violations.
Inspectors wroteBased on observation, staff interview, and review of staffing schedules, review of the facility grievance log, and review of policy and procedure, the facility failed to respond to an allegation of abuse and protect the resident's right to be free from verbal abuse by a staff member for 1 of 1 sample resident (#1) reviewed. This failure resulted in a delay in an investigation which left the residents unprotected, and a determination of immediate jeopardy. The census was 28.
- G
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Inspectors wroteBased on medical record review, staff interview, facility grievance log review, policy and procedure review, and State Survey Agency incident database review, the facility failed to protect the resident's right to be free from verbal abuse by a staff member for 1 of 3 sample residents (#1) reviewed for abuse. This failure resulted in actual harm to resident #1 who experienced verbal abuse a reasonable person would have found humiliating, intimidating, demeaning, and degrading.
April 20, 2023Standard inspection · 4 citations
- D
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure a written notice of transfer was provided to the resident or resident's representative for 2 of 2 sample residents (#36, #41) who were hospitalized .
- D
Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.
Inspectors wroteBased on observation, medical record review, resident interview, and staff interview, the facility failed to ensure ostomy care was provided according to the care plan for 1 of 1 residents with an ostomy (#24).
- D
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.
Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure residents received a gradual dose reduction (GDR), unless contraindicated, for psychotropic medication for 1 of 5 sample residents (#5) reviewed for unnecessary medications.
- D
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 observation, and staff interview, the facility failed to ensure medications for resident use were not expired in 1 of 3 medication storage units ( secure unit medication cart).
Fire safety inspections
19 fire safety citations on file: 5 on November 20, 2025, 5 on June 27, 2024, 9 on April 20, 2023.
Every fire safety citation19 citations
- F
Have generator or other power source capable of supplying service within 10 seconds.
K 918 · November 20, 2025 · Corrected (the home has a date of correction)
- F
Ensure proper usage of power strips and extension cords.
K 920 · November 20, 2025 · Corrected (the home has a date of correction)
- E
Provide properly protected cooking facilities.
K 324 · November 20, 2025 · Corrected (the home has a date of correction)
- E
Have approved installation, maintenance and testing program for fire alarm systems.
K 345 · November 20, 2025 · Corrected (the home has a date of correction)
- E
Properly install and monitor supervisory attachments on automatic sprinkler systems.
K 352 · November 20, 2025 · Corrected (the home has a date of correction)
- F
Inspect, test, and maintain automatic sprinkler systems.
K 353 · June 27, 2024 · Corrected (the home has a date of correction)
- F
Have simulated fire drills held at unexpected times.
K 712 · June 27, 2024 · Corrected (the home has a date of correction)
- F
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
K 914 · June 27, 2024 · Corrected (the home has a date of correction)
- F
Have generator or other power source capable of supplying service within 10 seconds.
K 918 · June 27, 2024 · Corrected (the home has a date of correction)
- E
Meet other general requirements.
K 200 · June 27, 2024 · Corrected (the home has a date of correction)
- F
Conduct testing and exercise requirements.
E 39 · April 20, 2023 · Corrected (the home has a date of correction)
- F
Have approved installation, maintenance and testing program for fire alarm systems.
K 345 · April 20, 2023 · Corrected (the home has a date of correction)
- F
Inspect, test, and maintain automatic sprinkler systems.
K 353 · April 20, 2023 · Corrected (the home has a date of correction)
- F
Properly select, install, inspect, or maintain portable fire extinguishes.
K 355 · April 20, 2023 · Corrected (the home has a date of correction)
- F
Have simulated fire drills held at unexpected times.
K 712 · April 20, 2023 · Corrected (the home has a date of correction)
- F
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
K 914 · April 20, 2023 · Corrected (the home has a date of correction)
- F
Have generator or other power source capable of supplying service within 10 seconds.
K 918 · April 20, 2023 · Corrected (the home has a date of correction)
- E
Have corridors or aisles that are unobstructed and are at least 8 feet in width.
K 232 · April 20, 2023 · Corrected (the home has a date of correction)
- E
Provide properly protected cooking facilities.
K 324 · April 20, 2023 · Corrected (the home has a date of correction)