Lakeland Hills 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.

39.9% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that worse than the national rate. This is CMS’s risk-adjusted rate over 70 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 52.3% 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 65 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 0.38 therapist hours per resident per day in 2026Q1 — more than 65% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 45% 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 120 beds and averages 114.3 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 3.21 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.39 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.04 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 3.04 hrs/resident/day on weekends vs 3.28 on weekdays — 7% thinner on weekends. RN hours go from 0.44 to 0.25 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 51% is about the same as 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.

32 citations, most serious first. The 13 most serious are shown; the remaining 19 are one tap away and print in full.

• Immediate jeopardy · K2025-04-11 · 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 the residents' right to be free from neglect for four residents (#4, #5, #3, and #2) out of six residents sampled related to 1) failure to accurately reconcile medications, 2) failure to follow-up on physician orders for laboratory testing, medical equipment, and outpatient services, 3) failure to provide medication with a physician's order, 4) failure to follow a physician's order for blood sugar testing, and 5) failure to implement hospice consultation orders. Serious harm occurred on [DATE], when Resident #4's seizure medications were not reconciled accurately, resulting in Resident #4 experiencing two seizures. After the seizures, physician ordered laboratory tests for seizure medication levels were not implemented, and Resident #4 had a third seizure resulting in a fall with head trauma and transfer to a higher level of care. Resident #4 subsequently died from his injuries. Serious harm occurred on [DATE], when Resident #5's seizure…

  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 · K2025-04-11 · tag F0726 — failed to have competent, trained nursing staff — pattern
  Ensure 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews, the facility failed to ensure licensed nursing staff were knowledgeable and competent to provide care and services for six residents (#4, #5, #1, #3, #6, and #2) out of ten residents sampled related to 1) failure to accurately reconcile medications upon admission, 2) failure to follow-up on laboratory orders, 3) failure to provide medication only with a physician's order, 4) failure to report and document malfunctions with a gastrostomy tube (G-tube), 5) failure to practice within the nursing scope of responsibility, 5) failure to follow a physician's order related to blood sugar testing, and 6) failure to implement hospice consultation orders. This failure created a situation that resulted in a worsened condition and the likelihood for serious injury and or death to residents and resulted in the determination of Immediate Jeopardy on 04/07/2025. The findings of Immediate Jeopardy were determined to be removed on 04/11/2025 and the scope and severity was reduced to an E…

  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 date of correction
• Immediate jeopardy · K2025-04-11 · tag F0760 — failed to prevent significant medication errors — pattern
  Ensure that residents are free from significant medication errors.
  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 ensure three residents (#4, #5, and #3) out of six residents sampled for medication administration were free from a significant medication error as evidenced by 1) failure to accurately reconcile medications upon admission, and 2) failure to provide physician ordered medications. Serious harm occurred on [DATE], when Resident #4's seizure medications were not reconciled accurately, resulting in Resident #4 experiencing two seizures. After the seizures, physician ordered laboratory tests for seizure medication levels were not implemented, and Resident #4 had a third seizure resulting in a fall with head trauma and transfer to a higher level of care. Resident #4 subsequently died from his injuries. Serious harm occurred on [DATE], when Resident #5's seizure medications were not reconciled accurately, resulting in seizure like activity requiring a transfer to a higher level of care. This failure created a situation that resulted in a worsened condition…

  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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-04-16 · 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, interview, and review of facility policy, the facility failed to accurately document procedures for a Cardiopulmonary Resuscitation (CPR) event for one (#2) of three resident reviewed for CPR.Findings included:A review of Resident #2's clinical chart, the face sheet documented an admission date [DATE]; and readmission date of [DATE]; with a discharge date of [DATE]. A diagnosis list included: Severe hypoxic ischemic encephalopathy (HIE). Resident #2's clinical chart revealed Advanced Directives of Full Code.On [DATE], Resident #2's clinical chart was reviewed. The progress notes; the assessments; there was no indication of CPR (Cardiopulmonary Resuscitation) being performed on the resident on [DATE].A review of an EMS (Emergency Medical Services) county Fire Rescue report documented a run report of emergency services arriving to the facility on [DATE] at 01:37:48. The report detailed the dispatch was for Cardiac Arrest, CPR was initiated by staff at 0055. EMS provided medication support…

  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
• Potential for harm · E2026-03-12 · tag F0761 — failed to label and store drugs safely — pattern
  Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, record reviews, and interviews the facility failed to ensure medications were stored in accordance of current professional standards for two (Residents #128 and #57) of 25 sampled residents and in four of four medication carts. Findings included: An observation was made on 3/9/26 at 12:08 p.m. of Resident #57's bedside dresser drawer, which was partially open. The observation revealed a box of Cold & Flu medication. The resident stated no one had told her she couldn't have medications at bedside. The resident reported having a cold the other week and spouse had brought in the medication. On 3/11/26 at 11:13 a.m. Staff M, Registered Nurse (RN) and Staff O, Licensed Practical Nurse (LPN) observed and removed 2 tablets of daytime cold & flu medication and a bottle of antacid tablets from the bedside dresser of Resident #57. The resident informed Staff M of being told about not keeping medications without an order. The staff members stated residents are not allowed to keep meds at bedside. On 3/11/25 at 10:55 a.m. an observation was made with Staff G, Licensed…

  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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-03-12 · tag F0565 — failed to support the resident council — isolated
  Honor the resident's right to organize and participate in resident/family groups in the facility.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, record reviews, and interviews the facility failed to provide a private space for the resident council to meet and failed to respond to the council's concerns and/or suggestions during five of six Resident Council Meeting Minutes. Findings included: On 3/10/26 at 2:35 p.m. a resident council meeting was held in the dining room between the 100/200 halls and the 300/400 halls. The dining room was open between the two units with a half wall separating the spaces, across from the screened porch leading to the smoking patio, and a hallway for staff, residents, and visitors between the units. The residents were separated among several tables. A family member of Resident #83 also attended the meeting. The president stated the dining room was the location of resident council meetings. The residents and family member reported the facility does not have a private space for them to meet. On 3/10/26 at approximately 3:00 p.m., during the meeting, a corporate staff member was observed standing behind a portion of the full wall in the 300/400 hall next to the dining room…

  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 date of correction
• Potential for harm · Dcited before2026-03-12 · tag F0584 — failed to keep a safe, clean, comfortable home — isolated
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews, the facility failed to ensure water temperatures were comfortable for one (400 hall) of four hallways sampled. Findings included: An interview on 3/9/2026 at 4:15 P.M. with Resident #52 was conducted. Resident #52 said the water does not get hot even if it's left on. Resident #52 said she frequently washes up with cold water. An observation on 3/12/2026 at 10:40 A.M., of the back hall hot water heater revealed a temperature gauge beyond the mixing valve was 108 degrees Fahrenheit. To enter the room Staff B, Maintenance Director (DM) used a flathead screwdriver to break the lock into the water heater room. During an observation on 3/12/2026 at approximately 10:40 A.M.,in two resident rooms, water was left running for five minutes, water temperature in room [ROOM NUMBER]'s room sink was 102.3 degrees Fahrenheit and the water temperature in room [ROOM NUMBER]'s bathroom sink was 101.8 degrees Fahrenheit. When placing fingers in the water the water was not cold…

  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 date of correction
• Potential for harm · Dcited before2026-03-12 · tag F0645 — isolated
  PASARR screening for Mental disorders or Intellectual Disabilities
  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 obtain Preadmission Screening and Resident Review (PASARR) Level II evaluations for (#8 and #9) of thirty-five initially sampled residents prior to facility admission.Findings included: Review of Resident #8's admission Record showed the resident was admitted on [DATE] and 11/12/25. The record included diagnoses not limited to not elsewhere classified anoxic brain damage, unspecified depression, bipolar-type schizoaffective disorder, and cognitive communication deficit. Review of Resident #8's PASARR Level I screening, dated 12/18/25, revealed mental illness diagnoses of depressive disorder, schizoaffective disorder, and insomnia with the findings based on documented history and medications. The PASARR had been completed by the facility's current Director of Nursing (DON). The screening showed the resident did not have or may have had a disorder resulting in functional limitations of major life activities that would be otherwise be…

  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
• Potential for harm · Dcited before2026-03-12 · tag F0656 — failed to write and follow a full care plan — isolated
  Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and interview the facility failed to create a resident centered care plan for two (Resident #8 and #36) related to medications out of five residents sampled. Findings included: Review of Resident #36's diagnosis includes Alzheimer's disease, schizoaffective disorder, bipolar type, bipolar disorder, depression, and generalized anxiety disorder. Review of Resident #36's Minimum Data Set (MDS) dated [DATE] revealed section N. Medications, antipsychotic, antidepressant, anti-anxiety and anticonvulsant medications. Review of Resident #36's care plan dated 11/26/25 revealed no care plan for antipsychotic, antidepressant, anti-anxiety or anticonvulsant medications. During an interview on 3/11/26 at 5:20 p.m., Staff H, Registered Nurse/Clinical Reimbursement Director (RN/CRD), stated residents should have care plans for medication they are taking. She reviewed Resident #36's care plan and stated she did not see a care plan for anti-anxiety, depression medication and psychotropic…

  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
• Potential for harm · D2026-03-12 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
  Provide care and assistance to perform activities of daily living for any resident who is unable.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record reviews and interviews, the facility failed to ensure residents received activities of daily living (ADL) care timely, for one (Resident #139) out of two residents reviewed for ADL care.Findings Included: During an interview on 03/09/2026 at 09:39 AM, Resident #139 stated having used a call light earlier in the day. Resident #139 stated staff answered the call light, and she told them she had urinated and had a bowel movement. Resident #139 stated she was changed two hours later. Resident #139 explained having again urinated and was waiting to be changed by staff at the time of the interview. The resident explained being upset about having to wait two hours to be changed by staff. During an interview on 03/11/2026 at 12:57 PM, Resident #139 stated at 11:00 AM, the Social Services Director (SSD), asked if assistance was needed. Resident #139 stated she told the SSD she had made a bowel and bladder movement and needed to be changed. Resident #139 stated having heard the SSD asking two Certified Nursing Assistants (CNA), to assist Resident #139 with being changed.…

  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 · D2026-03-12 · tag F0679 — failed to provide activities — isolated
  Provide activities to meet all resident's needs.
  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 provide life enriching activities for one (#2) of one dependent resident sampled for activities. Findings included: On 3/9/26 at 10:53 a.m. an observation was made of Resident #2 lying in bed. The resident did not respond verbally or physically when writer introduced self. The room contained four residents with variable responses. The observation showed resident #2 had a tracheostomy, gastrostomy tube, and an indwelling urinary catheter. The observation did not reveal music was playing for the resident. On 3/10/26 at 10:26 a.m. an observation was made of Resident #2 lying in bed, eyes partially open, non-responsive to verbalization. The observation showed urinary drainage bag leaking on floor. Staff L, Licensed Practical Nurse (LPN) was notified of the issue and confirmed the leaking of the bag. The observation did not reveal music was playing for the resident. On 3/11/26 at 3:38 p.m. an observation of Resident #2 lying in bed with eyes…

  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 · D2026-03-12 · tag F0693 — failed to provide proper feeding-tube care — isolated
  Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
  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 ensure two (Resident #2 and #122) of two residents reviewed were managed with professional standards and facility policy. Findings included: On 3/9/26 at 10:53 a.m. an observation was made of Resident #2 lying in bed, eyes open and was not responsive to verbal stimuli. The observation showed a nutrition pump next to the bed without a bottle of liquid nutrition hanging revealing the resident was not receiving nutrition at the time of the observation. On 3/10/26 at 2:00 p.m. an observation was made with Staff L, Licensed Practical Nurse (LPN) of the staff member connecting Resident #2's liquid nutrition to the gastronomy tube. The observation showed the bottle of nutrition was hanging with tubing already primed. The staff member stated Resident #2 was flushed with 320 milliliters (mL) every four (4) hours. Staff L used a 60 cubic centimeter (cc) syringe and plunger to push the contents of tubing into the stomach, removed the plunger from…

  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 · D2026-03-12 · tag F0745 — failed to provide medically-related social services — isolated
  Provide medically-related social services to help each resident achieve the highest possible quality of life.
  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 provide social services to one (Resident #11) out of 25 residents sampled.Findings Included:During an interview on 03/09/2026 at 10:52 a.m., Resident #11 stated he has not received a social security check in over a year. I have talked to several people and they tell me they are working on it and never follow up with me. I have no money to buy anything that I need.Review of Resident #11's minimum data set (MDS) dated [DATE] revealed Section C. Cognition, a brief interview mental status of 15 out of 15 showing intact cognition.Review of Resident #11's progress notes revealed:Social services progress note dated 6/5/2025, social services director (SSD) called the business office manager and inquired about the previous facility.SSD then called (other facility) and spoke with the Social Worker and asked about the belongings and any funds. She agreed to check and call this writer back. SSD will continue to follow.Social services progress note dated 12/26/2025:…

  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

“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

$139,373 in federal fines across 1 penalty. 1 Medicare payment denial on record.

• $139,373 — penalty dated 2025-04-11
• Medicare payment denial — starting 2025-06-12 for 17 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 HEARTHSTONE SENIOR COMMUNITIES — 8 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 19 rows in the source record cover these 13 parties — each is shown once here with every role it holds. Nothing is omitted.

7 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

About 76% 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 $219K 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