Lake Haven Nursing And Rehab Center

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

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.

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.

41.3% 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 26 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 55.0% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 20 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.25 therapist hours per resident per day in 2026Q1 — more than 35% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 29% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. 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.

Staffing

How full it usually is: this home is certified for 104 beds and averages 86.3 residents a day — about 83% occupied, or roughly 18 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 3.56 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.53 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.25 is below 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 3.35 hrs/resident/day on weekends vs 3.65 on weekdays — 8% thinner on weekends. RN hours go from 0.59 to 0.36 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 62% is well above the national median of 45%. 3 administrators have left in the past year — frequent leadership churn is a warning sign families often miss.

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.

37 citations, most serious first. The 17 most serious are shown; the remaining 20 are one tap away and print in full.

• Immediate jeopardy · Jcited before2024-03-29 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  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 observations, interviews and record reviews, the facility failed to protect the resident's right to be free from neglect by not ensuring one (#3) out of 14 residents at risk for elopement with a known history of exit seeking behaviors, and an expressed desire to leave the facility, was provided supervision and services to prevent elopement. The facility failed to ensure the secured unit exit door and door alarms were operating properly, failed to check the surroundings when the exit door alarmed, and failed to account for the whereabouts of all elopement risk residents on 3/6/2024. Resident #3 exited the secured unit of the facility via a maglock alarming dining room exit door on 3/6/24 at approximately 3:45 PM and was located at approximately 5:30 p.m. 0.8 miles away. The resident would have traveled across a busy 6-lane intersection with a speed limit of 45 MPH to reach this destination. The facility staff did not recognize the resident was missing. Resident #3 was returned to the facility…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Kcited before2024-02-22 · tag F0600 — failed to protect residents from abuse and neglect — pattern
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  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 interviews, the facility failed to protect resident's rights to eb free from medical neglect, failed to ensure individuals employed at the facility were licensed in accordance with applicable state laws to prevent medical neglect, when the facility failed to verify the identity, credentials, and licensure of an individual (Staff A) prior to employment as a registered nurse providing care and services for 19 shifts for 77 residents using a sample of 5 of 5 residents of the total 77 residents, Residents #6, #8, #4, #9, and #10. The failure of ensuring an individual is licensed as a registered nurse could result in the likelihood of harm and/or death to residents due to the lack of knowledge and education of medications and medication side effects. Medication side effects can be life-threatening, such as bleeding, sudden heart palpitations with the administration of bronchodilators, injecting insulin without the knowledge or education to check insulin quality, the proper syringe use, 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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Immediate jeopardy · K2024-02-22 · tag F0607 — failed to have anti-abuse policies — pattern
  Develop and implement policies and procedures to prevent abuse, neglect, and theft.
  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 policies and procedures were implemented to prohibit and prevent medical neglect when failing to ensure individuals employed at the facility were licensed in accordance with applicable state laws, when the facility failed to verify the identity, credentials, and licensure of an individual (Staff A) prior to employment as a registered nurse providing care and services for 19 shifts for 77 residents using a sample of 5 of 5 residents of the total 77 residents, Residents #6, #8, #4, #9, and #10. The failure of ensuring an individual is licensed as a registered nurse could result in the likelihood of harm and/or death to residents due to the lack of knowledge and education of medications and medication side effects. Medication side effects can be life-threatening, such as bleeding, sudden heart palpitations with the administration of bronchodilators, injecting insulin without the knowledge or education to check insulin quality, the proper syringe…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Immediate jeopardy · K2024-02-22 · tag F0835 — failed to run the facility competently — pattern
  Administer the facility in a manner that enables it to use its resources effectively and efficiently.
  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 and record review, the facility administration failed to administer the facility in a manner to effectively and efficiently attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident when the facility administration failed to ensure an employee (Staff A) had a Level II Background Screening, failed to implement policies and procedures to verify the identity, credentials and licensure of an individual (Staff A) prior to employment as a licensed practical nurse providing care and services for 19 shifts for 77 residents using a sample of 5 of 5 residents of the total 77 residents, Residents #6, #8, #4, #9, and #10. The failure of ensuring an individual is licensed as a registered nurse could result in the likelihood of harm and/or death to residents due to the lack of knowledge and education of medications and medication side effects. Medication side effects can be life-threatening, such as bleeding, sudden heart palpitations with the 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.

  Administration Deficiencies · Past Non-Compliance
• Immediate jeopardy · Jcited before2024-02-22 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure 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

  Based on record review, interviews, and facility policies and procedures, the facility failed to ensure adequate supervision for post fall care for one (Resident #4) of one resident reviewed for falls of a total of eleven sampled residents. Findings include: A review of Resident #4's clinical record revealed no presence of a face sheet or admission sheet. A review of resident #4's Minimum Data Set (MDS) record reflected an admission of 12/30/2023 from an acute care hospital. A review of Resident #4's diagnosis list, included: Urinary tract infection, nausea, edema-bi-lower extremities; thrombocytopenia; Hypotension; Leukocytosis; and Hypothyroidism. Record review of Nurse Progress notes, unsigned entry for Resident on 01/16/2024 at 1400: Pt (patient) fall today due to her knee gave up she said. Asked if she hit her head. Pt stated no, pt is stable and alert. No other emergency matter was taken. Helped from PT therapist (physicial therapist) putting pt back in bed. Pt again said she is fine and nothing is hurting after incident. Review of a telephone order dated 01/18/2024, 8:19…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2026-06-11 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure 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 interviews and record review, the facility failed to reevaluate and reassess interventions to prevent falls for one resident (#2) out of three reviewed. This resulted in Resident #2 sustaining a head laceration and transfer to acute setting for further evaluation. Findings included: Review of the facility's Incident Log showed Resident #2 had falls on 4/15/26 and 5/10/26. Review of Resident #2's progress noted showed:5/8/26 5:20 p.m. Patient found after unwitnessed fall with noted head injury. No acute distress noted. Upon assessment, light bleeding noted to head. Patient alert and responsive. Vital signs obtained and within normal limits (WNL). Provider notified of findings and new orders received for Computed Tomography (CT) scan. Patient transferred for CT scan per provider order. 5/10/16 10:47 a.m. Resident was noted to have an unwitnessed fall. Resident was observed lying on the floor, alert and at baseline mental status. Bleeding noted to the right side of the head. First aid was administered and…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has plan of correction
• Actual harm · Gcited before2025-01-16 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  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 interviews, the facility failed to protect residents' rights to be free from verbal and physical abuse perpetrated by a staff member (Staff J, Certified Nursing Assistant) toward two residents (#11 and #12) of seventy-four residents in the facility. On 12/20/2024, Staff J, Certified Nursing Assistant (CNA) was witnessed by Staff I, CNA slapping Resident #11 and Resident #12 on the legs, sides of their bodies, and buttocks during care. Staff I, CNA failed to report the abuse until three days after the event, leaving other facility residents at risk of further verbal and physical abuse. Findings included: Review of Resident #11's admission Record showed the resident was admitted on [DATE] and had diagnoses including but not limited to unspecified quadriplegia, unspecified not intractable epilepsy without status epilepticus, sever intellectual disabilities, legal blindness as defined in USA, unspecified scoliosis, and gastrostomy status. Review of the quarterly Minimum Data Set (MDS)…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-06-30 · tag F0557 — pattern
  Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
  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 residents' right to retain and use their personal possessions. The facility did not return or replace missing personal items for two residents (Rooms #127 W and #111 P) out of two reviewed for missing belongings.Findings include: On 06/29/2026 at 9:32 AM, an interview with the resident in room [ROOM NUMBER] W revealed the resident had informed staff on several occasions that personal belongings were missing. The missing items included clothing, tennis shoes, and a blanket. The resident reported staff had labeled the items with the resident's name using a black marker. The resident said the missing items were neither returned nor replaced. On 06/29/2026 at 9:40 AM, an interview with the resident in room [ROOM NUMBER] P revealed the resident had reported missing personal items to several facility staff members and had not received any resolution regarding the missing items. A review of the grievance log revealed six grievances filed…

  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.

  Resident Rights Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · E2026-06-30 · tag F0725 — failed to have enough nursing staff — pattern
  Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
  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 sufficient nursing staff to provide adequate supervision and prevent accidents. On 06/28/2026 during the 11 PM-7 AM shift, the facility assigned only one Certified Nursing Assistant (CNA) to the East Unit and one CNA to the Reflections Unit, affecting three residents (Residents #30, #117-P, and #111-P) out of three residents interviewed regarding staffing concerns. Residents reported delays in care and needing to rely on other residents for assistance due to inadequate staffing. Findings include:A review of the facility's Daily Assignment Sheet dated 06/28/2026 for the East Unit revealed one CNA was assigned to Rooms 100-128 for the 11 PM-7 AM shift. A review of the Daily Assignment Sheet for the Reflections Unit revealed one CNA was assigned to Rooms 200-210 for the same shift. A review of the Daily Assignment Sheet for the [NAME] Unit revealed two CNAs were assigned: one CNA was assigned to one resident in room [ROOM NUMBER] and the other 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.

  Nursing and Physician Services Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · E2026-06-30 · tag F0921 — failed to keep a safe, functional, sanitary building — pattern
  Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
  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 observations, interviews and record review, the facility failed to maintain resident rooms in a safe, functional, and comfortable condition by not ensuring air conditioning (A/C) units were operational, adequately sealed, and free of environmental contaminants, and free from bio growth, in two units (100 and 200) out of three units observed. This resulted in room temperatures exceeding 81 degrees Fahrenheit and unsealed wall openings exposing residents to outside elements. Findings include: On 6/29/26 at 3:24 p.m., an interview was conducted with Resident #2. Upon entry into the room, a noticeable increase in temperature was observed. Resident #2 stated the air conditioner had been broken since before they moved into the room. Resident #2 stated the facility was aware of the non functional A/C and provided a fan until repairs could be completed. Resident #2 stated they had lived in the room for at least three weeks without A/C, and their family member brought an additional fan due to the heat. Resident…

  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.

  Environmental Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · Ecited before2026-06-11 · tag F0584 — failed to keep a safe, clean, comfortable home — pattern
  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations and interviews, the facility did not ensure adequate supply of linens for two (100 and 200) out of three units in the facility.Findings included: An observation was conducted on 6/1/26 at 9:10 a.m. of the linen closet on the 100 unit. There were no towels or washcloths in the closet. An interview was conducted on 6/1/26 at 1:45 p.m. with Resident #8. She said there is a problem with having towels and washcloths. Resident #8 stated when they do get towels, they are very rough. Resident #8 said she could shower herself but often had to wait because there were no towels available. An interview was conducted on 6/1/26 at 5:11 p.m. with Resident #7. Resident #7 stated on multiple occasions that towels were not available for showers. Resident #7 said it would be nice to have towels when showering. An interview was conducted on 6/1/26 at 12:56 p.m. with Staff E, Certified Nursing Assistant (CNA). She said there were concerns regarding having linens available for residents, specifically towels. She said often residents had to wait to receive showers until towels were…

  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.

  Resident Rights Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · D2026-06-11 · tag F0578 — failed to honor advance directives / code status — isolated
  Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
  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 interviews and record review the facility failed to ensure advanced directives were implemented as requested for one resident (#2) out of three reviewed.Findings included: Review of admission Records showed Resident #2 was admitted on [DATE] with diagnoses including cirrhosis of liver, thrombocytopenia, chronic obstructive pulmonary disease, and hepatic encephalopathy. Review of Resident #2's orders showed an active order for Full Code, dated 4/19/26. Review of Resident #2's medical record revealed a signed Do Not Resuscitate (DNR) order signed by the resident's healthcare surrogate on 5/7/26. The DNR was not signed by a provider until 5/26/26. Review of the DNR books at the nurses' stations did not show a DNR form for Resident #2. An interview was conducted on 6/1/26 at 4:14 p.m. with Staff A, Licensed Practical Nurse (LPN). Staff A said she was assigned to care for Resident #2. Staff A said if a resident were to go into cardiac arrest she would check the resident's orders and the DNR book to confirm…

  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.

  Resident Rights Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · D2026-06-11 · tag F0610 — failed to investigate and act on abuse reports — isolated
  Respond 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 record review, observations, and staff interviews, the facility failed to fully implement its abuse prevention policy by not preventing Resident #11 from further accessing alleged victims and by not implementing effective interventions to protect other residents from additional abuse for two residents (#9 and #12) of three residents sampled.Findings included: During an interview on 6/11/26 at 1:22 p.m., the facility's psychiatric ARNP (advanced registered nurse practitioner) reported she saw Resident #11 weekly due to behavioral concerns. She stated on 4/23/26, she evaluated him after staff reported he had touched another resident inappropriately. At that time, he had been placed on 1:1 supervision two days earlier. The ARNP stated a CNA (Certified Nursing Assistant) witnessed Resident #11 groping Resident #12, who was his roommate. Both residents were assessed and then placed on 1:1 supervision together in the same room. The ARNP said that on 5/22/26, staff contacted telehealth to report a second…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · Dcited before2026-06-11 · tag F0684 — failed to provide proper treatment and quality of care — isolated
  Provide 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 observations, record review, and interviews the facility failed to assess and monitor one (Resident #10) of one resident following an off-campus accident resulting in a transfer to an acute care facility by emergency services for examination and testing.Findings included: An observation on 06/11/2026 at 12:06 p.m. showed Resident #10 sitting in wheelchair in the resident's room. The resident was alert and oriented during the observation and interview. Resident #10 reported sometimes having a different kind of stabbing pain. The resident reported being hit by a car in the parking lot of the store across the street from the facility while sitting in the wheelchair. Resident #10 reported grabbing the wheelchair frame under and slightly in front of the armrests while the car hit the side of the chair. The resident did not fall out of the chair and was transferred to the acute care facility by emergency services. Resident #10 stated upon returning to the facility, everyone asked me how I was. Resident #10…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has plan of correction
• Potential for harm · Ecited before2025-10-13 · tag F0684 — failed to provide proper treatment and quality of care — pattern
  Provide 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 observation, interviews and record reviews the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, related to failure to ensure weekly skin checks were completed for two residents (#2 and #3) of three sampled residents. Findings included: Resident #3 was admitted to the facility on [DATE] and discharged on 09/07/25. Review of the admission record showed diagnoses included but not limited to vascular dementia with other behavioral disturbance, stage III chronic kidney disease, diabetes, anxiety disorder, major depressive disorder, and cerebrovascular disease. Review of the physician orders for Resident #3 showed to perform weekly skin checks. Review of the skin evaluation dated 09/05/2025 showed - scratches on the bilateral arms. Multiple superficial scratches to bilateral arms. Dried blood present around the affected area. No active bleeding observed. Review of Resident #3's electronic medical record (EMR) revealed there were no other…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-06-12 · tag F0684 — failed to provide proper treatment and quality of care — pattern
  Provide 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 and record review, the facility failed to provide wound care for three residents (#2, #3, and #4) of three residents reviewed. Findings included: Review of Resident #2's admission Record revealed Resident #2 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses to include unspecified injury at T11-T12 level of thoracic spinal cord, subsequent encounter, wedge compression fracture of lumbar vertebra, wedge compression fracture of thoracic vertebra, multiple myeloma not having achieved remission, and other co-morbidities. Resident #2 discharged to the hospital on 5/11/2025. Review of Resident #2's Medical Certification for Medicaid Long-Term Services and Patient Transfer Form (AHCA Form 3008) dated 4/30/2025 under the section titled Skin Care - Stage and Assessment revealed: 1. Left leg skin tear; 2. 4 punctures - spine status post (s/p) kyphoplasty; 3. RU (right upper) leg skin tear. Review of Resident #2's Specialty Physician Wound Evaluation & Management Summary…

  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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-06-12 · tag F0842 — failed to keep accurate, complete medical records — isolated
  Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted 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 record review and interviews, the facility did not ensure medical records were completed and accurate for one resident (#2) out of three sampled residents. Findings included: Review of admission Records showed Resident #2 was admitted to the facility from the hospital on 5/2/25 and discharged from the facility on 5/11/25. On 6/11/25 at 10:30 a.m. Resident #2's Nursing admission Screening/History, dated 5/2/25, was reviewed. The Nursing admission Screening/History was blank with the exception of the vitals signs that auto populate when the documented is initiated. There was no documentation under the sections for admission details, level of consciousness/orientation/neurological, social history/lifestyle concerns, general appearance, HEENT (head, eyes, ears, nose throat), respiratory/chest, cardiac/circulation, GI (gastrointestinal)/bowel, GU (genitourinary)/bladder, extremities/gait/mobility, skin, ADL's (activities of daily living)/functional devices, other relevant diagnoses/concerns, pain, and…

  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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction

“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.

Fines & penalties

$281,689 in federal fines across 5 penalties. 1 Medicare payment denial on record.

• $12,542 — penalty dated 2024-10-02
• $59,462 — penalty dated 2024-10-02
• $8,624 — penalty dated 2024-02-22
• $8,624 — penalty dated 2024-02-22
• $192,437 — penalty dated 2024-02-22
• Medicare payment denial — starting 2024-12-11 for 91 days

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 ELIYAHU MIRLIS — 13 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 →

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

CMS files one row per role, so the 10 rows in the source record cover these 6 parties — each is shown once here with every role it holds. Nothing is omitted.

2 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 85% 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 $117K paid to related parties (affiliated landlords or management companies) in its most recent cost report.

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 FL