Fernandina Beach Rehabilitation And Nursing Center
1625 Lime Street, Fernandina Beach, FL 32034 · For profit - Limited Liability company · 120 certified beds · (904) 261-0771 Medicare & Medicaid certified
This home has serious findings on its record. Read them closely before you consider it.
- a middle-of-the-pack inspection score (3/5)
- fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
- it has an abuse, neglect, or exploitation citation (F0600), cited Jun 2024
- it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
- it has 1 actual-harm citation
- a high number of inspection citations overall (17) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- the CMS record shows $31,051 in federal fines (most recent 2024-06-27)
- its facility-reported quality-measure score sits well above its independent inspection score
- its payroll-based staffing rating is low (2/5)
- nursing-staff turnover (59%) runs well above the national median (45%)
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 | 3 of 5 |
| StaffingFrom payroll records (PBJ) | 2 of 5 |
| Quality measuresSelf-reported by the facility | 5 of 5 |
Worth a closer look. This home's quality-measure rating runs 2 stars above its independent health-inspection score. The inspection is done by state surveyors; the quality-measure score leans on data the facility reports about itself — so a gap this large is worth reading the inspection record for.
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
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 | 5 of 5 |
| Long-stay residentspeople who live here | 5 of 5 |
| Short-stay residentsrehab / post-hospital | 5 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 held steady at 2 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 | 7.2% | 8.7% | 15.4% | better |
| Long-stay residents who lose too much weight | 9.3% | 5.5% | 5.4% | worse |
| Long-stay residents with a catheter left in their bladder | 0.0% | 0.3% | 0.9% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with a urinary tract infection | 0.0% | 0.7% | 2.0% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with depressive symptoms | 0.0% | 4.6% | 6.5% | check this* — see note marked star below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 1.4% | 2.5% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 9.1% | 9.5% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 12.9% | 14.4% | 18.9% | better |
| Long-stay residents given the seasonal flu vaccine | 100.0% | 99.2% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 1.6% | 4.5% | 4.7% | better |
| Long-stay residents with worsening bladder/bowel control | 19.5% | 10.5% | 21.2% | typical |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 13.6% | 8.6% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 0.2% | 1.5% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 92.4% | 94.7% | 79.4% | better |
| Short-stay residents rehospitalized after admission | 20.0% | 26.1% | 22.6% | better |
| Short-stay residents with an outpatient ER visit | 4.5% | 9.1% | 12.0% | better |
| Long-stay hospitalizations per 1,000 resident days | 0.88 | 2.13 | 1.67 | better |
| Long-stay outpatient ER visits per 1,000 resident days | 1.29 | 1.15 | 1.80 | better |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ 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.
53.0% 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 269 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 68.9% 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 90 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 0.37 therapist hours per resident per day in 2026Q1 — more than 63% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 13% 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.
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 | 53.0%CMS range 47.5–58.8 | 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 | 10.4%CMS range 8.0–13.0 | 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 | 68.9% | 56.6% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | 64.4% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 64.4% | 50.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | 98.6% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | 97.2% | 100.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this 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 | 98.8% | 98.7% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | 0.7% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 2.0% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 8.4%CMS range 5.2–12.1 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 1.01 | 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 120 beds and averages 114.5 residents a day — about 95% occupied, or roughly 6 beds typically open. It runs essentially full — expect a waiting list. 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 3.35 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.35 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.06 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 3.09 hrs/resident/day on weekends vs 3.46 on weekdays — 10% thinner on weekends. RN hours go from 0.43 to 0.15 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 59% is well above the national median of 45%. 2 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 fewer than at the previous inspection — improving. 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.
17 citations, most serious first. The 11 most serious are shown; the remaining 6 are one tap away and print in full.
- Actual harm · G2024-06-27 · tag F0600 — failed to protect residents from abuse and neglect — isolatedProtect 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
Based on medical record review and interviews, the facility failed to protect, in a timely manner, the resident's right to be free from verbal abuse/threat to deprive the resident of services by a staff member for one (Resident #79) of a total of 42 residents in the sample. The findings include: During an interview with Resident #79 on 06/25/24 at 1:20 PM, she stated, Staff ignore me. No one will answer my call light. The staff are always outside my door laughing at me in the hallway since the other day. She stated on Sunday (06/23/24) she reported the following incident to Social Services Director (SSD) P, stating, [Certified Nursing Assistant (CNA) M] told me that I could not go back to bed after my therapy session, and I had to stay up for two hours. I was in a lot of pain, and I asked for pain medication, but the nurse did not bring it. I told the other CNA that [CNA M] should not keep doing this to me. I did call her (CNA M) a bitch when I said that. [CNA M] came back into my room and told me her name was not bitch. She grabbed her name badge and pulled it down and said, My…
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 · D2026-04-09 · tag F0628 — isolatedProvide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
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 reviews, interviews and a review of the facility's policy and procedure, the facility failed to provide a notice of transfer/discharge and a copy of the actual transfer/discharge form to the Long-Term Care Ombudsman's Office for three (Residents #7, #71 and #125) of five residents reviewed for transfer/discharge.The findings include:1.A review of Resident #7's medical record revealed an admission date of 1/16/26 with diagnoses including a fracture of the upper end of her left humerus (upper arm). She was discharged on 3/18/26.A review of the resident's minimum data set (MDS) assessment dated [DATE], revealed a Discharge, Return Not Anticipated assessment. A review of the resident's physician's orders revealed that on 3/18/26, the resident had orders to discharge to another facility the same day (3/18/26) with supportive services.A review of the resident's care plan revealed a Focus Area indicating an expressed desire to discharge to the community (Initiated on 1/19/26).A review of the resident's…
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 · F2024-06-27 · tag F0623 — widespreadProvide 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 staff interview, the facility failed to 1) Provide the appropriate transfer/discharge notice to the resident and their responsible party, and 2) Notify the Office of the State Long-Term Care Ombudsman in writing of a resident transfer to the hospital for one (Resident #70) of two residents reviewed for transfer/discharge and hospitalization, from a total sample of 42 residents. The findings include: A review of Resident #70's medical record revealed that she was transported to the hospital on 4/30/24 for right foot pain, fever, and nausea. A progress note dated 5/3/24 revealed that she was transferred back/readmitted to the facility on [DATE] from the hospital with a diagnosis of cellulitis to the right lower extremity. On 6/26/24 at 3:30 PM, an interview was conducted with the Administrator, who was informed that Resident #70's medical record contained no notification in writing to the resident's representative or the local Ombudsman of the resident's transfer to the hospital 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 · E2024-06-27 · tag F0692 — failed to prevent malnutrition and dehydration — patternProvide enough food/fluids to maintain a resident's health.
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 maintenance of acceptable parameters of nutritional status, by failing to provide nutritional interventions in a timely manner to prevent significant weight loss for two (Residents #57 and #34) of five residents reviewed for nutrition, from a total sample of 42 residents. The findings include: 1. During a tour of the facility on 06/25/24 at 9:38 AM, Resident #57 was observed lying in her bed. She appeared thin. A review of the resident's medical record revealed she had suffered weight loss. On 12/23/23, Resident #57 weighed 108 pounds, and on 06/18/24, she weighed 84.7 pounds. This indicated the resident lost 21.57% of her body weight within six months. She was admitted to the facility on [DATE] with a medical history significant for dementia, anxiety, depression, weakness, transient ischemic attack (TIA), and osteoarthritis. A review of the Quarterly Minimum Data Set (MDS) assessment, completed on 04/12/24, 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.
- Potential for harm · E2024-06-27 · tag F0698 — failed to provide proper dialysis care — patternProvide 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
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews, and interviews, the facility failed to 1) Provide meals for one (Resident #23) of four residents receiving hemodialysis, and 2) Complete communication information forms for three (Residents #55, #413, and #13) of four residents receiving hemodialysis. The findings include: 1. On 6/25/24 at 10:30 AM, Resident #23 left for her dialysis appointment and did not receive a lunch or snack to take with her. Upon her return at 4:00 PM, she stated she was supposed to take a lunch with her; however, none was provided to her. This happens all the time. She said she had not had anything to eat since breakfast and was now having to wait until dinner time to eat. She confirmed that the facility was supposed to provide a snack or a lunch to take with her, but they never do. The resident's sister, present during this interview, stated, I am here every day, and they have not provided a lunch for her since her admission that I know of. (admitted on [DATE]) I usually buy her snacks to 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 · D2024-06-27 · tag F0584 — failed to keep a safe, clean, comfortable home — isolatedHonor 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
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations and interviews, the facility failed to maintain a clean and home-like environment in four (Rooms 106, 114, 163, and 166) of 62 occupied rooms. The findings include: On 6/25/24 from 9:00 AM to 1:00 PM, the following observations revealed environmental concerns: room [ROOM NUMBER] had bubbled paint around the air conditioner unit, built-up dust and debris on the air conditioner vent, and the air conditioner unit was detached from the wall. room [ROOM NUMBER] had black-colored markings on the air conditioner unit's front panel (resembling biological growth), built-up dust and debris on the air conditioner vent, and the air conditioner was detached from the wall. room [ROOM NUMBER]-A had trim falling off the wall behind the bed's headboard. room [ROOM NUMBER]-A had trim behind the bed's headboard that was detached from the wall and the dresser's top drawer was broken. (Photographic evidence obtained) On 6/27/24 at 9:12 AM, a follow-up tour was conducted with Environmental Director/Plant…
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 · D2024-06-27 · tag F0609 — failed to report abuse allegations — isolatedTimely 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 medical record review and interviews, the facility failed to ensure that all alleged violations involving abuse/mistreatment and misappropriation of resident property, were reported no later than two hours after the allegation was made, if the events that caused the allegation involved abuse, to the Administrator and to other officials, including the State Survey Agency, for one (Resident #79) of 42 residents in the survey sample. The findings include: During an interview with Resident #79 on 06/25/24 at 1:20 PM, she stated, Staff ignore me. No one will answer my call light. The staff are always outside my door laughing at me in the hallway since the other day. She stated on Sunday (06/23/24) she reported the following incident to Social Services Director (SSD) P, stating, [Certified Nursing Assistant (CNA) M] told me that I could not go back to bed after my therapy session, and I had to stay up for two hours. I was in a lot of pain, and I asked for pain medication, but the nurse did not bring it. I told the other CNA that [CNA M] should not keep doing this to me. I did…
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 · D2024-06-27 · tag F0625 — isolatedNotify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review, interview, and facility policy review, the facility failed to provide a Bed Hold notice to one (Resident #70) of two residents reviewed for transfer/discharge to acute care settings, from a total sample of 42 residents. The findings include: A review of Resident #70's medical record revealed a progress note dated 4/30/24 indicating that the resident was transported to an acute care hospital on 4/30/24. The record did not contain a Bed Hold notice for the transfer. On 6/27/24 at 10:07AM, an interview was conducted with the Administrator. The Administrator stated no Bed Hold notice was issued for the resident regarding her transfer to the hospital on 4/30/24. A review of the facility's policy titled Attachment A, Bed Hold Policy and Notification (Undated), revealed that it was facility policy to inform residents/legal representatives upon admission and after leaving the facility for hospitalization, observation, or therapeutic leave, of the facility's Bed Hold Policy and Notification. The policy indicated each resident/legal representative would be informed by…
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 · D2024-06-27 · 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
Based on observations, interviews, and record review, the facility failed to maintain proper storage of medications for three (Residents # 51, #65, and #6) of 112 residents observed during the initial tour of the facility, one resident (#41) during an observation at one nurses' station (Station 2), and in one medication cart (Station 2 - C Hall) during a medication storage observation. The findings include: 1. On 6/25/24 at 9:29 AM, an observation was made of Resident #51's over-the-bed table, which revealed a clear medication cup sitting there with two orange-colored pills in the cup. Resident #51 stated the medication was her Vitamin C chewable tablets, and she liked to suck on them after she took her other medications because she did not have any teeth. (Photographic evidence obtained) On 6/26/24 at 10:29 AM, an interview was conducted with Licensed Practical Nurse (LPN) H. When shown a photograph of the medication observed on Resident #51's over-the-bed table the previous day, LPN H stated the medication was indeed Resident #51's Vitamin C, and she confirmed that she should not…
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 · D2024-06-27 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard 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
Based on observations, record review, and interviews, the facility failed to maintain and document accurately on medication administration records for one (Resident #406) of 42 residents in the total sample. The findings include: A review of Resident #406's physician's orders revealed that the resident had an order for oxycodone HCI (narcotic pain medication) 10 mg (milligrams) every 4 hours as needed, ordered 6/18/24. A review of the June 2024 electronic Medication Administration Record (eMAR) revealed that Resident #406's Oxycodone 10 mg was documented as having been administered on 6/24/24 at 4:27 AM, 8:48 AM, and 1:53 PM. On the resident's narcotic sign-out sheet for Oxycodone 10 mg, the medication was signed out as having been administered on 6/24/24 at 4:27 AM and 1:53 PM. On the narcotic sign-out sheet, this medication was also signed out as having been administered on 6/24/24 at 8:26 PM, but it was not documented on the eMAR for this date and time. On 6/25/24, Oxycodone 10 mg was documented on the eMAR as having been administered at 9:39 PM, but the narcotic sign-out sheet…
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 · D2024-06-27 · 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
Based on a review of medical records and facility policy, and observations made during medication administration, the facility failed to implement infection control measures to prevent the spread of infection. Standard of practice hand hygiene procedures were not implemented during provision of care for two (Residents #406 and #72) of four residents observed during medication administration. The findings include: On 6/27/24 at 8:28 AM during a medication administration observation with LPN R, she was observed walking up to the medication cart, unlocking the cart, removing a medicine cup from the top drawer, locking the medication cart, and taking the medicine cup to Resident #406's room to administer the medication in the cup. LPN R did not perform hand hygiene before or after administering medications to the resident. When LPN R returned to the medication cart, she unlocked the cart, pulled medication cards from the drawer, reviewed orders for each medication, placed medication that was to be administered in a medicine cup, locked the cart and entered Resident #72's room to…
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 6 citations
- Potential for harm · D2024-06-27 · tag F0883 — failed to offer flu and pneumonia vaccines — isolatedDevelop and implement policies and procedures for flu and pneumonia vaccinations.
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 assess residents' pneumococcal vaccination status in a timely manner for two (Residents #454 and #406) of five residents reviewed for vaccination status, from a total sample of 42 residents. The findings include: A record review for Resident #454, revealed that she was admitted to the facility on [DATE], and her assessment for pneumococcal vaccination status was due by 6/10/24. A record review for Resident #406, revealed that she was admitted to the facility on [DATE] and her assessment for pneumococcal vaccination status was due by 6/21/24. A review of residents' pneumococcal vaccination status was conducted on 6/27/24 at 2:30 PM with the Director of Nursing (DON), who confirmed that she was the acting Infection Preventionist for the facility. Five residents were selected for review regarding their pneumococcal vaccination status. The DON stated she was new to the role of Infection Preventionist and she was not in this role when Residents #454 and 406…
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 · E2024-02-27 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — patternProvide appropriate pressure ulcer care and prevent new ulcers from developing.
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, interviews, and facility policy review, the facility failed to ensure that four (Residents #13, #14, #11, and #3) of eight residents with pressure ulcers, from a sample of 18 residents, received care consistent with professional standards of practice, to prevent pressure ulcers and receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing. The findings include: 1. A review of Resident #13's medical record revealed she was admitted to the facility on [DATE] and discharged to emergency room care on 1/21/24. A review of the Minimum Data Set (MDS) assessment Section M (Skin Conditions) dated 12/26/23 revealed the resident was assessed as at risk for developing pressure ulcers, and on that date did not have any pressure ulcers. The next MDS evaluation for Section M (Skin Conditions), dated 1/21/24, revealed the resident has one unstageable pressure ulcer/deep tissue…
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 · F2022-11-09 · tag F0867 — failed to act on quality-improvement findings — widespreadSet up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interviews and record review, the facility failed to 1) Maintain an effective system to obtain and use feedback and input from direct-care staff, other staff, residents, and resident representatives, including how such information would be used to identify problems that are high risk, high volume, or problem-prone, and opportunities for improvement; 2) Maintain an effective system to identify, collect, and use data and information from all departments, including but not limited to the facility assessment, and include how such information would be used to develop and monitor performance indicators; 3) Develop, monitor, and evaluate performance indicators, including the methodology and frequency for such development, monitoring, and evaluation; and 4 ) Conduct distinct performance improvement projects that reflected the scope and complexity of the facility's services and available resources, as reflected in the facility assessment. The findings include: In an interview on 11/09/22 at 5:58 PM, the Administrator was asked about the facility's Quality Assurance and Performance…
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 · D2022-11-09 · tag F0688 — failed to keep residents mobile / prevent decline — isolatedProvide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, interviews, and record review, the facility failed to give residents with limited mobility appropriate services, equipment, and assistance to maintain or improve mobility with maximum practicable independence unless a reduction in mobility was demonstrably unavoidable. This impacted one resident (#23) reviewed for care and services out of 18 residents with contractures, and from a total sample of 34 residents. Failure to provide appropriate range of motion (ROM) and splinting can result in increased pain and worsening of contractures. The findings include: A review of Resident #23's medical record revealed an admission date of 8/22/22 and diagnoses including nontraumatic intracerebral hemorrhage, pancreatitis, cirrhosis of liver w/o ascites, cardiomyopathy, polyneuropathy, history of falling, spondylolisthesis, ataxic gait, major depressive disorder, and spinal stenosis with fusion of spine. A review of the resident's minimum data set (MDS) assessment, dated 8/26/22, revealed a brief interview for mental status (BIMS) score of 15 out of a possible 15 points,…
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 · D2022-11-09 · tag F0726 — failed to have competent, trained nursing staff — isolatedEnsure 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 interviews and record review, the facility failed to ensure that all licensed nurses and certified nursing assistants demonstrated competencies and skills sets necessary to care for residents' needs, as identified through resident assessments and described in the plan of care. There were 107 residents in the facility at the time of the survey who were at risk of receiving substandard care and services. The findings include: On 11/08/22 at 11:00 AM, Resident #564 stated he thought his blood sugar was high maybe 441 this morning. He could not recall if he had received any insulin coverage. He further stated he still felt like his blood sugar was high because he didn't feel well. In an interview on 11/08/22 at 11:40 AM, Licensed Practical Nurse (LPN) A (Agency) was asked about Resident #564's blood sugar reading. She looked it up in the electronic medical record and stated that it was 445 milligrams per deciliters (mg/dL) at 9:59 AM and that she had administered 22 units of insulin. When asked if she had notified the physician, she stated that there was no order to call 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 · B2024-06-27 · tag F0582 — patternGive 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 interviews, the facility failed to provide form CMS-10055 (Skilled Nursing Facility Advance Beneficiary Notices) to two (Residents #55 and #456) of three residents sampled for review of beneficiary notices. The findings include: A review of Resident #55's medical record revealed that her Medicare Part A Skilled services began on 1/5/24 and ended on 2/28/24. Resident #55's CMS 10055 form was not provided. A review of Resident #456's medical record revealed that his Medicare Part A Skilled services began on 3/9/24 and ended on 4/15/24. Resident #456's CMS 10055 form was not provided. On 6/26/24 at 2:35 PM, an interview was conducted with Regional Field Analyst U. She stated the Social Services Department was responsible for filling out and providing the forms. She further stated the CMS 10055 forms were not completed because the Social Services Department was not aware of it. On 6/26/24 at 2:36 PM, an interview was conducted with Social Services Director P. She stated she was not aware that she had to complete the CMS 10055 forms. She further stated she…
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.
- 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
$31,051 in federal fines across 3 penalties.
- $5,358 — penalty dated 2024-06-27
- $10,538 — penalty dated 2024-06-27
- $15,155 — penalty dated 2024-06-27
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 ASTON HEALTH — 38 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 | 4 of 5 | 2.7 | +1.3 vs chain |
| Health inspection | 3 of 5 | 2.5 | +0.5 vs chain |
| Staffing | 2 of 5 | 2.2 | -0.2 vs chain |
| Quality measures | 5 of 5 | 4.1 | +0.9 vs chain |
The other 37 homes this chain runs (chain average 2.7★, 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 |
|---|---|---|---|---|
| FB REHAB HOLDINGS, LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | since 12/03/2018 |
| QUALITY REHAB PARTNERS LLC | Organization | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 100% | since 06/20/2019 |
| BLATT, MARC | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 01/01/2025 |
| CINE, NASLINE | Individual | OPERATIONAL/MANAGERIAL CONTROL | — | since 07/30/2024 |
| JORDAN, HILTON | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 08/01/2019 |
| REED, QUINTANA | Individual | OPERATIONAL/MANAGERIAL CONTROL | — | since 07/10/2024 |
| WILDES, DONNA | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 08/26/2025 |
| ASTON HEALTHCARE LLC | Organization | ADP OF THE SNF | — | since 01/01/2022 |
CMS files one row per role, so the 11 rows in the source record cover these 8 parties — each is shown once here with every role it holds. Nothing is omitted.
3 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.
This home reported $2.0M paid to related parties — landlords or management companies under common ownership — equal to about 16% 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 FL
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 Florida 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.
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 105470. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-04-09, 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.