Maple Springs Of Palmer
12130 East Maple Springs Way, Palmer, AK 99645 · For profit - Limited Liability company · 67 certified beds · (907) 802-6641 Medicare & Medicaid certified
This home has serious findings on its record. Read them closely before you consider it.
- a high payroll-based staffing rating (4/5)
- it has citations for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0609, F0610) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
- it has a citation for mishandling residents’ money or property (F0568)
- inspectors cited 1 immediate-jeopardy problem — the most serious level
- a high number of inspection citations overall (36) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- the CMS record shows $46,594 in federal fines (most recent 2025-03-27)
- its payroll-based staffing score sits well above its independent inspection score
- its independent health-inspection rating is low (1/5)
- its facility-reported quality-measure rating is low (2/5)
- nursing-staff turnover (60%) runs well above the national median (45%)
- about 26% of its spending goes to commonly-owned related companies
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 1 of 5 |
| StaffingFrom payroll records (PBJ) | 4 of 5 |
| Quality measuresSelf-reported by the facility | 2 of 5 |
Worth a closer look. This home's staffing rating runs 3 stars above its independent health-inspection score. The inspection is done by state surveyors; the staffing score rests on the facility's own payroll (PBJ) submissions — so a gap this large is worth reading the inspection record for.
Location & what’s nearby
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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 2 of 5 |
| Long-stay residentspeople who live here | 2 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating fell from 2 to 1 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 11.2% | 16.7% | 15.4% | better |
| Long-stay residents who lose too much weight | 3.3% | 5.3% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 3.8% | 1.4% | 0.9% | worse |
| Long-stay residents with a urinary tract infection | 4.2% | 2.5% | 2.0% | worse |
| Long-stay residents with depressive symptoms | 3.5% | 6.5% | 6.5% | better |
| Long-stay residents who were physically restrained | 0.4% | 0.2% | 0.1% | worse |
| Long-stay residents with falls causing major injury | 1.2% | 3.2% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 26.2% | 19.5% | 16.1% | worse |
| Long-stay residents on antianxiety or hypnotic medication | 20.5% | 14.7% | 18.9% | typical |
| Long-stay residents given the seasonal flu vaccine | 100.0% | 96.0% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 10.1% | 6.9% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 22.3% | 20.0% | 21.2% | typical |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 17.8% | 18.8% | 17.1% | typical |
| Short-stay residents given the seasonal flu vaccine | 90.9% | 85.5% | 79.4% | better |
| Long-stay hospitalizations per 1,000 resident days | 1.58 | 1.00 | 1.67 | typical |
| Long-stay outpatient ER visits per 1,000 resident days | 1.61 | 1.36 | 1.80 | better |
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
49.5% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 39 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Therapy staffing: this home’s payroll records show 0.33 therapist hours per resident per day in 2026Q1 — more than 56% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 1% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 49.5%CMS range 36.9–67.1 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 10.8%CMS range 7.1–16.3 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 1.20 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 67 beds and averages 55.0 residents a day — about 82% occupied, or roughly 12 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 5.54 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.58 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.86 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 4.91 hrs/resident/day on weekends vs 5.79 on weekdays — 15% thinner on weekends. RN hours go from 1.58 to 1.59 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 60% is well above the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
36 citations, most serious first. The 11 most serious are shown; the remaining 25 are one tap away and print in full.
- Immediate jeopardy · Kcited before2025-03-27 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — patternEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, interview, and record review, the facility failed to ensure the resident environment was free of accident hazards. Specifically, the facility failed to: 1) Establish safety measures for proper cigarette disposal and the use of required adaptive devices, identified during smoking safety assessments, for residents who smoke tobacco on the facility's campus for 5 residents (#'s 9, 10, 21, 32, and 47), out of 7 total residents who smoked; 2) Complete annual smoking safety screening assessments for 4 residents (#'s 9, 21, 32, and 47), out of 7 total residents who smoked; 3) Complete smoking safety screening assessments for 3 residents (#'s 12, 25, and 54), out of 3 total residents who used electronic cigarettes (known as vapes); and 4) Secure lighters within the facility for 6 residents (#'s 9, 10, 21, 32, 47, and 53), out of 7 total residents who smoked. These failed practices placed all 9 residents at immediate risk of injury and/or death and placed all residents (based on a census of 60) at…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2025-08-05 · tag F0609 — failed to report abuse allegations — patternTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and interview, the facility failed to immediately report an allegation of verbal abuse to the State Survey Agency in accordance with CFR (Code of Federal Regulations) S483.12 (b)(5) for 1 resident (#2), out of 4 sampled residents reviewed. Specifically, the facility failed to notify the State Survey Agency of alleged violations involving abuse no later than two hours after allegation was made. This failed practice had the potential for continued abuse and placed vulnerable residents at risk of harm .Record review on 8/4-5/25 revealed Resident #2 was admitted to the facility with diagnoses that included Parkinson's disease (a brain disorder that affects movement and causes tremors, stiffness and slowness), anxiety disorder (a mental disorder characterized by uncontrollable feeling of anxiety and fear), post-traumatic stress disorder (a mental health condition that is caused by extremely stressful or terrifying event) and depression.Review of the IDT [Interdisciplinary Team] Care Conference 1.0 note, dated 7/17/25 at 2:01 PM, revealed: [Resident #2] has also…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2025-08-05 · tag F0610 — failed to investigate and act on abuse reports — patternRespond appropriately to all alleged violations.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and interview, the facility failed to respond to an allegation of verbal abuse for 1 resident (2), out of 4 sampled residents reviewed, in accordance with CFR (Code of Federal Regulations) S483.12(c). Specifically, the facility failed to:1) thoroughly investigate allegations of verbal abuse;2) prevent further potential abuse while the investigation was in progress; and3) report results of an investigation to the State Survey Agency within 5 working days of the incident to include verification of allegations and corrective actions taken.This failed practice resulted in Resident #2's unhappiness in the facility and fear of retaliation. This failed practice also placed Resident #2 at risk of continued abuse and receiving care in a less-than-optimal setting .Record review on 8/4-5/25 revealed Resident #2 was admitted to the facility with diagnoses that included Parkinson's disease (a brain disorder that affects movement and causes tremors, stiffness and slowness), anxiety disorder (a mental disorder characterized by uncontrollable feeling of anxiety and fear),…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Fcited before2025-06-05 · tag F0908 — failed to keep essential equipment working — widespreadKeep all essential equipment working safely.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, facility policy review, and review of the manufacturer's manual, the facility failed to conduct monthly inspections of seven of seven facility owned Hoyer (mechanical) lifts and of lifts owned by two of two (Resident (R) 2 and R6) residents with personal mechanical lifts. This failure increased the risks of accidents due to mechanical failure. Findings include: Review of the facility's policy titled, Specialized Medical Equipment, dated 04/04/24, revealed, . Maple Springs will ensure that all specialized medical equipment is identified and assessed for safety and necessity . Review of the undated MedLine Battery Operated Patient Lift manual, provided by the Maintenance Director (MD), revealed, . At least once a month, the patient lift should be thoroughly inspected to recognize any signs of wear, and/or looseness of bolts or parts. Replace any worn parts immediately . Always follow the maintenance and cleaning schedule closely and fully while including any specific…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2025-06-05 · tag F0609 — failed to report abuse allegations — patternTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, and review of facility policy, the facility failed to report injuries of unknown origin and allegations of abuse and neglect immediately to the Resident Advocate (RA) and within two hours to the State Survey Agency (SSA) for three of three residents (Resident (R) 3, R1, and R5) reviewed for abuse and neglect out of a total sample of six. Failure to report injuries of unknown origin and allegations of abuse and neglect places residents at risk for continued potential abuse. Findings include: Review of the facility's policy titled, Abuse Policies, dated 12/2023, revealed, . All allegations of abuse and/or neglect will be reported to the Administrator and/or designee, including incidents involving injured resident's where the origin of the injury in [sic] unknown . Facility will report immediately, but not later than two hours after forming the suspicion or allegation, if the events that cause the suspicion or allegation result in serious bodily injury, or not later than 24 hours…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-06-05 · tag F0610 — failed to investigate and act on abuse reports — isolatedRespond appropriately to all alleged violations.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, and review of facility policy, the facility failed to thoroughly investigate an allegation of abuse and bruising of unknown origin for two of five residents (Resident (R) 3 and R1) reviewed for abuse and neglect out of a total sample of six. Failure to thoroughly investigate allegations of neglect and injuries of unknown origin places residents at risk for potential continued abuse. Findings include: Review of the facility's policy titled, Abuse Policies, dated 12/2023, revealed, . All allegations of abuse and/or neglect will be reported to the Administrator and/or designee, including incidents involving injured resident's where the origin of the injury in [sic] unknown . All pertinent information will be reviewed during the investigation . A list of witnesses and other persons knowledgeable about the event will be compiled . Interviews will be conducted with the following individuals: a. The individual(s) making the report. B. The individual(s) alleged to be involved with the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-06-05 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, record review, and facility policy review, the facility failed to complete skin assessments for one of six sampled residents (Resident (R) 1) whose records were reviewed. Failure to complete routine skin assessments placed residents at increased risk of alterations in skin integrity. Findings include: Review of the facility's policy titled, Resident Assessment, revised 02/2024, revealed, . Head-to-toe assessments will be performed by nursing staff at least weekly on all residents . Physical Exam: . Skin: a. intactness; b. moisture; c. color; d. texture; e. presence of bruises . The following information should be recorded in the resident's medical record . All assessment data obtained during the procedure . Review of R1's Profile tab of the electronic medical record (EMR) revealed R1 was admitted to the facility on [DATE] with diagnoses that included dementia, nondisplaced fracture of the sacrum, hallucinations, and unspecified fracture of the thoracic vertebrae. Review of R1's Care Plan,…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-06-05 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and review of facility policy, the facility failed to ensure one of three residents (Resident (R) 2) reviewed for the use of mechanical lifts out of a total sample of six was transferred in a safe manner, using two people as per facility policy. Failure to transfer residents in a safe manner placed R2 at risk for injury. Following the incident, the facility identified and implemented a Performance Improvement Plan (PIP) to ensure staff followed the facility's policy requiring two staff members when using a mechanical lift. Findings include: Review of the facility's policy titled, Lifting Machine, Using a Mechanical, dated 07/2017, revealed, . At least two (2) nursing assistants are needed to safely move a resident with a mechanical lift . Review of R2's Profile tab of the electronic medical record (EMR) revealed the resident was admitted to the facility on [DATE] with diagnoses that included hypertensive heart and chronic kidney disease with heart failure. Review…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · F2025-03-27 · tag F0726 — failed to have competent, trained nursing staff — widespreadEnsure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and interview, the facility failed to ensure nursing staff had the appropriate skill sets to administer medications accurately for 1 resident (#8), out of 9 residents observed for medication administration. Specifically, the Licensed Nurse (LN) removed and administered a medication from a blister pack (a 30-day supply of medications in a card with bubbled packaging for individual doses of the medication) that was not labeled for the intended recipient. This failed practice placed the resident at risk for potential adverse outcomes of medication errors, or the possibility of running out of medications that were borrowed. Findings: Resident #8 Record review on 3/23-27/25 revealed Resident #8 was admitted to the facility with diagnoses that included unspecified injury at C1 level of cervical spinal cord, sequela (past injury at the top of the spinal cord in the neck that has resulted in long term or residual effects, such as weakness, paralysis, or other neurological impairments) and quadriplegia, unspecified (partial or complete paralysis of all four limbs, often…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Fcited before2025-03-27 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, record review, and interview, the facility failed to ensure: 1) concentrations of kitchen sanitizing solutions were maintained within acceptable parameters to ensure it adequately cleaned kitchen surfaces; and 2) concentrations of fruit and vegetable cleaning solution was maintained within acceptable parameters to ensure produce was appropriately cleaned prior to being served to residents. These failed practices created a potential for food borne illness and/or cross contamination for 57 residents who received food from the kitchen. Findings: Sink & Surface Cleaner Sanitizer An observation on 3/25/25 at 11:15 AM, revealed three red buckets that were labeled on the front that stated, Ecolab Sanitizing Solution Only. One bucket was located on the bottom shelf of the food preparation line table used by the cooks while plating meals, one was located by the dishwashing station, and one bucket was located by the food preparation sinks. During an interview on 3/25/25 at 11:25 AM, [NAME] #1…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Fcited before2025-03-27 · tag F0908 — failed to keep essential equipment working — widespreadKeep all essential equipment working safely.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure a produce wash solution dispenser was in operating condition. This failed practice placed 57 residents that received food from the kitchen at risk for foodborne illnesses and communicable diseases from subquality cleaning of fresh produce. Findings: An observation on 3/25/25 at 11:18 AM, revealed a produce wash solution dispenser labeled, Ecolab Antimicrobial Fruit & Vegetable Treatment to the right side of the food preparation sinks. It was also observed that there were test strips on top of the dispenser, and it was noted that a blue water pipe was on the right side of the dispenser with a water line connecting to the dispenser. During an interview on 3/25/25 at 11:25 AM, [NAME] #1 stated this solution was used to wash produce prior to being prepared and served to the residents. Review on 3/26/25 of the Ecolab Antimicrobial Fruit & Vegetable Treatment Test Strip, used by the facility, with an expiration date of February 2026 and November 2026, revealed the following instructions: .Immerse the strip…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 25 citations
- Potential for harm · Dcited before2025-03-27 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review, observation, and interview, the facility failed to ensure one resident (#48), out 15 sampled residents, was provided care in a manner that promoted dignity and respect. Specifically, staff failed to cover the resident's buttocks and genitals, for dignity, while staff walked away to empty a urinal. This failed practice had the potential to cause the resident humiliation and shame. Findings: Record review from 3/23-27/25 revealed Resident #48 was admitted to the facility with diagnoses that included Parkinsons disease (a degenerative disorder of the central nervous system characterized by tremor and impaired muscular coordination), left femur fracture, osteoporosis (a disorder characterized by abnormal loss of bone density and deterioration of bone tissue), history of strokes, and heart failure. Review of Resident #48's care plan Interventions, revised on 10/7/24, revealed: The resident requires extensive assistance on (1) staff for toilet use . An observation on 3/23/25 at 9:26 AM, revealed Resident #48 in his/her room, standing up in front of his/her recliner…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-03-27 · tag F0558 — failed to accommodate residents' needs and preferences — isolatedReasonably accommodate the needs and preferences of each resident.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review, interview, and observation, the facility failed to ensure reasonable accommodation of needs, of always having a call light within reach, was maintained for 1 resident (#39), out of 15 sampled residents reviewed. This failed practice placed the resident at risk for not being able to call for help if needed. Findings: Resident #39 Record review on 3/23-27/25 revealed Resident #39 was admitted to the facility with diagnoses that included dysphagia following nontraumatic intracerebral hemorrhage (difficulty swallowing due to bleeding in the brain not caused by trauma, due to damage affecting the brain regions responsible for controlling swallowing), unspecified dementia, unspecified severity, with other behavioral disturbance (a decline in intellectual functioning, including problems with memory, reasoning and thinking without enough information to identify a specific type or cause), seizures and anemia. During an interview on 3/24/25 at 9:34 AM, Resident #39's Resident Representative (RR) stated he/she video-called with Resident #39 frequently. The RR further…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-03-27 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review, interview, and observation, the facility failed to ensure care plans were individualized to meet the communication needs for 1 resident (#34), out of 15 sampled residents. Specifically, the care plan failed to: 1) address how staff should communicate with this nonverbal resident; and 2) contain interventions that were individualized or resident-centered for Resident #34. This failed practice placed the resident at risk for not receiving the necessary interventions to attain the highest practicable physical, mental, and psychosocial well-being. Findings: Record review on 3/23-27/25 revealed Resident #34 was admitted to the facility with diagnoses that included hemiplegia (paralysis on one side of the body) and hemiparesis (weakness on one side of the body) following a nontraumatic intracerebral hemorrhage (brain bleed) affecting the left non dominant side. Resident #34 was nonverbal with contractures of all limbs and hands and relied entirely on staff for every aspect of cares and interactions. During an interview on 3/24/25 at 9:23 AM, Resident #34's Power of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2025-03-27 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to update and revise the care plan for 2 residents (#'s 47 and 54), out of 15 sampled residents. Specifically, the facility failed to update and revise the care plans to reflect: 1) Discontinuation of contact barrier precautions and antibiotic medication use for Resident #47; and 2) Initiation of anticonvulsant (medication used to prevent or control seizures) medication use and discontinuation of enteral feedings (process of delivering nutrition directly into the gastrointestinal tract, usually through a tube, for individuals who cannot eat enough by mouth but have a functioning digestive system) for Resident #54. These failed practices placed the residents at risk for not receiving appropriate and/or accurate care and services. Findings: Resident #47 Record review on 3/23-27/25 revealed Resident #47 was admitted to the facility with diagnoses that included quadriplegia (paralysis of all four limbs), orthopedic aftercare following surgical amputation, and a stage 4 pressure ulcer of the sacral region (most…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2025-03-27 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a sanitary environment to help prevent the development of infections. Specifically, the facility failed to ensure: 1) Suction tubing and a yankauer tip (a hard plastic handle, placed on the suction tubing, with a rounded, open tip for suctioning in a resident's mouth) remained clean and sanitary for 1 resident (#29), out of 15 sampled residents; and 2) A urinary catheter (a medical device that helps drain urine from the bladder) bag was hung in a manner to remain clean and sanitary for 1 resident (#55), out of 14 residents with catheters. These failed practices placed the residents at risk for infection which could have affected his/her overall health and wellbeing. Findings: Resident #29 Record review on 3/23-27/25 revealed Resident #29 was admitted to the facility with diagnoses that included central pontine myelinolysis (a neurological condition involving severe…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · F2024-01-08 · tag F0756 — failed to review each resident's drug regimen — widespreadEnsure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review, interview, and observation, the facility failed to ensure: 1) monthly medication regimen reviews (MRR) were completed for 5 residents (#'s 2, 3, 14, 16, and 29), out of 5 residents reviewed for unnecessary medications; and 2) a physician order included all the required medication concentration parameters for 1 resident (#10), out of 14 sampled residents. These failed practices had the potential to decrease oversight of the residents' medication orders, which could have led to medication errors and adverse consequences. Findings: Medication Regimen Review: Record review on 1/2-5/24 and 1/8/24 revealed Residents #2, #3, #14, #16, and #29's monthly medication regimen reviews, for July and October 2023, were not completed by the facility's pharmacist. During an interview on 1/8/24 at 1:20 PM, Pharmacist #1 stated the monthly medication regimen reviews had not been completed in July or October 2023. The pharmacist also stated this was not the normal process and was an oversight. Medication Administration Observation: During the medication administration…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Fcited before2024-01-08 · tag F0761 — failed to label and store drugs safely — widespreadEnsure 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.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure expired medical products were removed and replaced from the second-floor medical emergency code cart (crash cart/emergency cart/equipment used for resuscitation). This failed practice placed residents in the facility (based on a census of 54), that had a full code status, at risk for adverse effects or complications from use of expired products during an emergency. Findings: Expired medical products: An observation and concurrent interview with Licensed Nurse (LN) #3 on 1/4/24 at 1:38 PM, of the second-floor crash cart, revealed the following expired medical supplies: 1 - EvenCare glucose controls 8 ml bottle, expired on 7/1/23; and 1 - Proview tests strips 50 count, expired on 12/9/23. LN #3 stated the expired items should have been replaced right away. LN #3 then disposed and replaced the items in the second-floor emergency code cart. LN #3 stated the nurse educator was responsible to check the crash cart for expired medications but did not know how often it happened. He/She also stated he/she was…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Fcited before2024-01-08 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, interview, and record review, the facility failed to: 1) store food in proper sanitary condition; and 2) ensure hairnets were worn and handwashing was performed by staff handling food. These failed practices placed residents, based on a census of 54, who received food from the kitchen, at risk for foodborne illnesses and communicable disease. Findings: Food Storage: An observation on 1/2/24 at 9:25 AM, of the main kitchen, revealed several food items were expired or not labeled correctly in the following storage areas: Walk in refrigerator: - Partially cut green onion bunches in a quart sized zip lock bag, expired date 12/27/23; - Shelf width plastic container containing approximately 12 pieces of thawed cod in a plastic bag with a used by date of 12/30/23; - 1 gallon [NAME] Fine Red Wine Vinegar, opened, no opened or used by dates; - 1 container of clam base opened 9/25/23, no used by date; - 1-quart sized zip lock bag containing 16 oz package of Saf-Instant instant yeast, no open or…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2023-01-17 · tag F0550 — failed to protect resident dignity and rights — patternHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure a culture where residents were treated with dignity and respect for 5 residents (#'s 283; 133; 25; 12; and 286) out of 39 residents. This failed practice placed the residents at risk for psychological harm from feelings of poor self-esteem and/or self-worth and a potential for a poor quality of life. Findings: Resident #283 Record review on 1/8-12/23 and 1/17/23 revealed Resident #283 had diagnoses which included stroke and right sided hemiplegia (weakness on one side of the body). During an observation on 1/8/23 at 11:55 AM, Resident #283 was served a meal that included beans and chicken enchilada. Resident #283's silverware was tightly wrapped in a cloth napkin which was set on the right side of the table. The resident used his/her left hand to begin eating, with his/her hands, and wiped his/her food-soiled hand on a tissue from a box of Kleenex placed on the table. Resident #283 was unable to lift his/her right arm, due to the stroke, and was unable to open the napkin wrapped silverware placed on…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2023-01-17 · tag F0568 — patternProperly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview and record review, the facility failed to 1) provide quarterly statements of personal fund accounts to 3 residents (#'s 6; 10; and 26) and/or their representatives, out of 3 residents sampled for personnel funds; and 2) obtain consent to open and maintain a trust account in the facility for 1 resident (#10) out of 14 sampled residents. These failed practices placed all residents wanting the facility to manage their funds (based on a census of 39) at risk for not receiving a complete and accurate accounting of their personal funds entrusted to the facility; and not maintaining acceptable accounting principles. Findings: Quarterly statements: During an interview on 1/8/23 at 11:26 AM, Resident #6 stated he/she had not received quarterly statements from the facility. During an interview on 1/12/23 at 11:57 AM, the Business Office Manager (BOM) stated 3 residents had a trust account with the facility. The BOM further stated she did not send quarterly statements to the Residents' guardians. The BOM stated she sent the guardians an email with the interest rates and what…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2023-01-17 · tag F0583 — failed to protect personal privacy — patternKeep residents' personal and medical records private and confidential.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review and interview, the facility failed to ensure that 8 residents' rights to privacy (#s 1; 4; 8; 21; 23; 29; 30; and 101) were maintained out of a census of 39 residents. This failed practice violated the residents' right to personal privacy of his / her protected health information (PHI). Findings: During an observation on 1/11/23 at 9:48 AM, a report sheet with eight resident names including Residents # 1; 4; 8; 21; 23; 29; 30; and 101 was observed laying face up on a medication cart on the hospice hall. Included on the report sheet were code status (documents whether the resident would choose resuscitation if his/her heart stopped), diagnoses, diet orders, bowel and bladder status, transfer ability, assistive devices used, limitations, therapy ordered, and other notes for these eight names listed on the report sheet. Anyone passing by in the hall had the potential to read / view this document, which had private confidential information on it. The staff returned at 9:50 AM and placed the report sheet face down. Review of the facility's policy HIPAA…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2023-01-17 · tag F0812 — failed to store, cook, and serve food safely — patternProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and interview, the facility failed to ensure food was stored under proper sanitary conditions. This failed practice placed the residents (from a total census of 39) who ate chicken and bacon in their diets at risk of food-borne illnesses. Findings: An observation of the walk-in refrigerator on 1/8/23 at 9:20 AM revealed 6 slices of bacon were left on top of a plastic bag and open to air. The plastic bag and the bacon were inside an opened cardboard box marked as containing 15 pounds of bacon. The box of bacon was dated as received on 1/3/23. Further observation with concurrent interview revealed there were 6 pieces of chicken in a plastic bag which had been opened and were thawing. Part of the plastic strip of the opening of the bag was on the floor and the bag was opened and not sealed. The Weekend Kitchen Supervisor stated the chicken and the bacon were incorrectly stored. During an interview on 1/8/23 at 10:25 AM, the Weekend Kitchen Supervisor stated there were no policies regarding safe thawing of meat and further stated the bacon was to be kept in the box…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2023-01-17 · tag F0880 — failed to prevent and control infections — patternProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review, and interview, the facility failed to ensure acceptable professional standards of infection prevention and control were followed. Specifically, the facility failed to ensure: 1) staff performed hand hygiene with glove use during perineal cares (cleaning the genital areas of the resident) for 1 resident (#284) out of 14 sampled residents; 2) community glucometers were cleaned and disinfected properly in between resident use for 1 sampled resident (#13) and 2 unsampled residents (#2 and #16); 3) staff used Personal Protective Equipment (PPE) during transfer of a resident on enhanced barrier precautions (EBP) for 1 resident ( #13) out of 4 residents on EBP; and 4) the Hospice Licensed Nurse (LN) performed standard precautions with wound care for 1 hospice resident (#4) out of 2 hospice residents observed. These failed practices had the potential to affect all residents, based on a census of 39, for risk of contamination and spread of infectious diseases. Findings: Hand Hygiene During an observation on 1/10/23 at 3:31 PM, Certified Nursing Aide (CNA)…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-01-17 · tag F0623 — isolatedProvide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on record review and interview, the facility failed to ensure 3 (#'s 31; 139; and 140) of 4 discharged records reviewed were provided with a complete discharge notice which included a location for a safe discharge. Failure to provide the required information at the time of discharge may have prevented a resident and / or resident representative from active participation in decisions regarding the resident's care and may have prevented the resident and / or resident representative from exercising their right to appeal the transfer and to ascertain knowledge that the discharge was facilitated to a safe location. Findings: Resident #139 Record review on 1/8-12/23 and 1/17/23 revealed Resident #139 was admitted to the facility with diagnoses that included Guillain-Barre syndrome (a disorder of the immune system where the nerves are attacked by immune cells that causes weakness and tingling in arms and legs) and a history of encephalitis (a life-threatening inflammation of the brain). Record Review of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2023-01-17 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure professional standards of practice with flushing a PEG (percutaneous endoscopic gastronomy) tube (a flexible feeding tube placed through the abdominal wall into the stomach or other locations of the intestines for feeding and/or medications) for 1 resident (#133) of 2 residents observed with PEG tubes. This failed practice had the potential to cause discomfort to the resident. Findings: An observation with concurrent interview on 1/10/23 at 2:10 PM, revealed Licensed Nurse (LN) #6 gathering supplies and medication for a scheduled medication administration and water flush through Resident #133's PEG tube. For the flush, LN #6 poured cold water from a community water pitcher at the nursing station into an 8 oz white paper cup. Ample amounts of ice were observed floating in the community water pitcher. Once in Resident #133's room, LN #6 stated the flush syringe (held in a volumized measuring container obtained from Resident #133's bathroom counter sink) did not have volume measurements, and the 8oz white…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-01-17 · tag F0698 — failed to provide proper dialysis care — isolatedProvide safe, appropriate dialysis care/services for a resident who requires such services.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and interview, the facility failed to ensure communication with the dialysis clinic for 1 resident (#6), out of 2 dialysis residents sampled, regarding a significant event. Specifically, the facility failed to notify the dialysis clinic of a bleeding event from the Resident's fistula site (a surgical connection between an artery and vein, usually in the arm, to allow blood from the body to be pulled out and into the dialysis machine and then returned using needles). The failure to notify the dialysis clinic regarding significant bleeding events incurred by the resident, denied the opportunity for potential treatment plan changes, and placed the resident at risk of harm and complications due to continued bleeding episodes. Findings: Record review from 1/8-12/23 and 1/17/23 revealed Resident #6 was admitted to the facility with diagnoses that included End Stage Renal Disease (ESRD) and anemia (lack of healthy red blood cells to carry adequate oxygen to the body's tissues). During an interview on 1/8/23 at 12:51 PM, Resident #6 stated he/she would sometimes have…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-01-17 · tag F0757 — failed to avoid unnecessary drugs — isolatedEnsure each resident’s drug regimen must be free from unnecessary drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and interview, the facility failed to ensure duplicative medications, ordered for constipation, were administered per facility protocol for 1 resident (#29) out of 5 residents sampled for unnecessary medication review. Specifically, as needed bowel medication orders did not include specific parameters for use and the bowel protocol was not followed. This failed practice had the potential to inadequately medicate the resident and prolong the resident's constipation. Record review from 1/8-12/23 and 1/17/23 revealed Resident #29 was admitted to the facility with a diagnosis that included heart failure, hypertension, and respiratory failure. Review of Resident #29's Order Summary Report, dated 1/10/23, revealed orders for: 1. Bisacodyl Suppository - Insert 1 suppository rectally every 24 hours, as needed, for constipation; 2. Milk of Magnesia Suspension - give 30 cc by mouth every 24 hours, as needed, for constipation; 3. Miralax powder- give 17 gram by mouth every 12 hours, as needed, for constipation. During an interview on 1/12/23 at 9:18 AM, when asked how…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2023-01-17 · tag F0759 — failed to keep medication error rate low — isolatedEnsure medication error rates are not 5 percent or greater.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure the medication error rate was not 5% or greater. During the Medication Administration Task, the facility failed to correctly administer 2 of 27 opportunities (7.41% error rate) of medications observed. Specifically, 1) Resident #12 was not offered an ordered medication; and 2) staff failed to ensure dosage for a medication administered to Resident #18 was measured. These failures placed the residents at risk for experiencing potential adverse effects of medications or not receiving medications as ordered. Findings: Resident #12 An observation on 1/10/23 at 9:03 AM, revealed LN #7 prepared medications for Resident #12. LN #7 did not offer the ordered medication for the resident to take nor provided education for the Trelegy Ellipta Aerosol Powder (an inhaled medication for asthma). Review of Resident #12's physician order, started 4/5/22, revealed: Trelegy Ellipta Aerosol Powder Breath Activated 200-62.5-25 MCG/INH (Fluticasone-Umeclidin-Vilant) 1 inhalation inhale orally one time a day for Asthma Rinse…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2023-01-17 · tag F0761 — failed to label and store drugs safely — isolatedEnsure 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.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation, interview, and policy review, the facility failed to ensure expired products were removed from use. Specifically, products used to treat wounds, and supply trays used for bladder catheter insertion had expired. This failed practice placed the residents who required such services, out of a census of 39, at risk complications from utilizing expired products. Findings: An observation on [DATE] at 12:54 PM, of the medication storage room, revealed a box containing Skintegrity Hydrogel (wound care product) with an expiration date of 10/2022. Further observation revealed all 49 one-ounce containers had the same expiration date. During an interview on [DATE] at 12:56 PM, Licensed Nurse (LN) #2 stated the Skintegrity Hydrogel was a product that provided moisture to wound beds. The LN further verified the expiration date and counted the number of expired containers. The LN stated the entire case had expired. When asked how the facility prevented expired products from reaching the residents, the LN…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2025-03-27 · tag F0836 — widespreadEnsure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and interviews, the facility failed to ensure state laws were followed regarding posting variance decisions. Specifically, the facility failed to ensure variance decisions were displayed in a conspicuous location where the posting could be readily viewed. This failed practice violated 7 Alaska Administrative Code (AAC) 10.940 and denied all residents (based on a census of 60) and resident representatives the right to the knowledge of criminal history of facility employees. Findings: Random observations on 3/23/25, revealed there were no visible variance decision postings in areas that were readily accessible to residents and/or the public throughout the facility. During an interview and concurrent observation on 3/25/25 at 3:31 PM, when asked about the location of the variance decision posting, the Human Resource (HR) Director pointed out its location on a wall beside the office supply shelves, which were located at the end of a back hallway by the Administration offices (which consisted of, but not limited to, the Administrator and Human Resource offices).…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2024-01-08 · tag F0577 — widespreadAllow residents to easily view the nursing home's survey results and communicate with advocate agencies.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview, observation, and record review, the facility failed to ensure notice of the availability of the State inspection results were posted in an area of the facility that was prominent and accessible to the public. This failed practice had the potential to deny the residents (based on a census of 54) and public knowledge of the location of the most recent survey results and plans of correction the facility had put into place. Findings: A resident council meeting with the State surveyor was called to order on 1/4/24 at 2:32 PM. Resident #'s 1; 3; 6; 12; 16; 17; 29; 31; and 41 were in attendance and each resident stated they attended the meetings regularly. When asked if the State inspection results were available to read, without having to ask, all residents in attendance stated they were unaware of the location of the State inspection results. One resident in attendance stated the State worker told him/her there was a binder with the results in the facility, but that resident stated he/she had not been able to locate the binder. An observation on 1/4/24 at 4:08 PM, of…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2024-01-08 · tag F0851 — widespreadElectronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview and record review, the facility failed to ensure accurate staffing data for the 4th quarter of 2023 (July to September 2023) was reported to Centers for Medicare and Medicaid (CMS) Payroll Based Journal (PBJ). This failed practice potentially denied residents and/or representatives (based on census of 54), and the public, accurate staffing data when accessing the Nursing Home Compare website. Findings: During an interview on 1/5/24 at 1:03 PM, Administrative Assistant (AA) #1 stated the facility used an online time clock system. She explained the staff hours and job codes were reported to the PBJ every quarter. Review of the facility's PBJ report for the 4th quarter of 2023 (July to September) revealed the following incorrect weekend job codes were reported: 16 entries were coded as 108- Registered Nurse (RN), 1 entry was coded as 116- RN NOC (Night shift), 2 entries coded as 111-RN On-call, 4 entries were coded as 126- LPN (License Practical Nurse) on Call, 1 entry was coded 107- Licensed Practical Nurse, 20 entries were coded as 103- SNF (Skilled Nursing…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2023-01-17 · tag F0574 — widespreadThe resident has the right to receive notices in a format and a language he or she understands.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on observation and record review, the facility failed to ensure information regarding residents' legal rights for all pertinent State regulatory and informational agencies were correctly provided. This failed practice had the potential to delay reporting. Findings: Observations, throughout the survey from 1/8-12/23, revealed documents posted on the wall near the first and second floor elevators with instructions on how to contact state and federal agencies for concerns or complaints. An observation on 1/12/23 at 2:30 PM revealed the posters had incorrect contact information for the State of Alaska Adult Protective Services (APS), with a listed address as 550 W 8th Ave, Anchorage, Alaska 99501. Review of contact information for APS accessed at State of Alaska Adult Protective Services website on 1/12/23, revealed the current address was 1835 Bragaw Street, Suite 350, Anchorage, AK 99508. Further observation of the posters revealed an incorrect phone number for the State of Alaska Health Facilities…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2023-01-17 · tag F0582 — widespreadGive residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and interview, the facility failed to 1) ensure the Notice of Medicare Non-Coverage [NOMNC] form was delivered to 1 resident (#3) or the resident representative, out of 5 Beneficiary Notification sampled residents, in a timely manner; and 2) inform each Medicaid-eligible resident, 38 residents out of a total census of 39, in writing, at the time of admission or when they became eligible for Medicaid, of charges for other items and services, not covered by Medicaid, that the facility offered. These failed practices 1) denied the resident a timely opportunity to appeal a denial of Medicare coverage and placed the resident at risk for not receiving covered services, and 2) had the potential to affect all Medicaid-eligible residents and their ability to be aware of potential charges that could have incurred during their admission. Findings: Notice of Medicare Non-coverage: Review on 1/12/23 at 10:00 AM of Resident #3's NOTICE OF MEDICARE NON-COVERAGE [NOMNC], revealed the resident's coverage of current services was ending on 9/25/22. Further review revealed the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- No harm found · C2023-01-17 · tag F0732 — widespreadPost nurse staffing information every day.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and interview, the facility failed to post the daily total number and the actual hours for resident care per shift worked by the Certified Nurse Aides (CNA), Licensed Practical Nurses (LPN), and Registered Nurses (RN). This failed practice provided inaccurate information to the residents and their families. Findings: An observation of the Direct Care staffing hours, from 1/8-12/23, posted outside of the Director of Nursing's office, revealed information which included the facility's census and the nursing staff (CNA, LPN, and RN) scheduled for the day. Further observation revealed on each nursing staff category the daily scheduled hours, previous days scheduled hours, previous days actual hours, and then the total nursing hours. Further review of the postings revealed the total number and actual work hours of nursing staff per shift was not documented. During an interview on 1/12/23 at 1:42 PM, when asked about the staffing hours poster, the Administrator stated the facility was required to post staffing hours of CNAs, LPNs, and RNs. The Administrator further…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
$46,594 in federal fines across 2 penalties.
- $38,691 — penalty dated 2025-03-27
- $7,903 — penalty dated 2024-02-05
Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.
Part of a chain
This home belongs to MAPLE SPRINGS LIVING — 3 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 1 of 5 | 3.0 | -2.0 vs chain |
| Health inspection | 1 of 5 | 2.7 | -1.7 vs chain |
| Staffing | 4 of 5 | 4.3 | -0.3 vs chain |
| Quality measures | 2 of 5 | 3.3 | -1.3 vs chain |
The other 2 homes this chain runs (chain average 3.0★, per CMS)
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Share | Since |
|---|---|---|---|---|
| BRONSHIELD LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST; ADP OF THE SNF | 9% | since 03/01/2025 |
| MAPLE SPRINGS OF MATSU HOLDINGS, LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST; ADP OF THE SNF | 65% | since 08/17/2017 |
| MORPHEUS UNIVERSE | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST; ADP OF THE SNF | 9% | since 03/01/2025 |
| PISTIS MERCURY | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST; ADP OF THE SNF | 9% | since 03/01/2025 |
| LARMED, LLC | Organization | 5% OR GREATER INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | 8% | since 01/01/2019 |
| CHRISTENSEN, JESSE | Individual | MANAGING CONTROL - GOVERNING BODY; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 03/01/2025 |
| LARSEN, NICHOLAS | Individual | CORPORATE OFFICER; ADP OF THE SNF | — | since 01/01/2019 |
| MAPLE SPRINGS MANAGEMENT LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 01/01/2019 |
| JACHIMIEC, JESSICA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 03/01/2025 |
| PATH ACCOUNTING LLC | Organization | ADP OF THE SNF | — | since 03/01/2025 |
CMS files one row per role, so the 20 rows in the source record cover these 10 parties — each is shown once here with every role it holds. Nothing is omitted.
7 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
About 90% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $4.2M paid to related parties — landlords or management companies under common ownership — equal to about 26% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in AK
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Alaska Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner. The starred figure is the national median (no state figure published).
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 025039. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-03-27, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.