Aviata At Grand Oaks
3001 Palm Coast Parkway SE, Palm Coast, FL 32137 · For profit - Corporation · 120 certified beds · (386) 446-6060 Medicare & Medicaid certified
This home has serious findings on its record. Read them closely before you consider it.
- fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
- inspectors cited 3 immediate-jeopardy problems — the most serious level
- a high number of inspection citations overall (21) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- the CMS record shows $15,646 in federal fines (most recent 2024-06-07)
- its facility-reported quality-measure score sits well above its independent inspection score
- its independent health-inspection rating is low (1/5)
- its payroll-based staffing rating is low (2/5)
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 1 of 5 |
| StaffingFrom payroll records (PBJ) | 2 of 5 |
| Quality measuresSelf-reported by the facility | 5 of 5 |
Worth a closer look. This home's quality-measure rating runs 4 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 improved from 1 to 3 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 | 5.8% | 8.7% | 15.4% | better |
| Long-stay residents who lose too much weight | 4.0% | 5.5% | 5.4% | better |
| 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 | 7.0% | 4.6% | 6.5% | typical |
| 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 | 1.5% | 2.5% | 3.3% | better |
| Long-stay residents whose ability to walk worsened | 12.4% | 9.5% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 10.5% | 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 | 4.1% | 4.5% | 4.7% | better |
| Long-stay residents with worsening bladder/bowel control | 10.9% | 10.5% | 21.2% | typical for the state‡ — see note marked double-dagger below the table |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 2.0% | 8.6% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 0.7% | 1.5% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 100.0% | 94.7% | 79.4% | better |
| Short-stay residents rehospitalized after admission | 20.1% | 26.1% | 22.6% | better |
| Short-stay residents with an outpatient ER visit | 4.2% | 9.1% | 12.0% | better |
| Long-stay hospitalizations per 1,000 resident days | 1.09 | 2.13 | 1.67 | better |
| Long-stay outpatient ER visits per 1,000 resident days | 0.29 | 1.15 | 1.80 | better |
‡ 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.
60.8% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 182 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 59.0% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 156 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 0.42 therapist hours per resident per day in 2026Q1 — more than 72% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 22% 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 | 60.8%CMS range 53.5–68.3 | 51.5% | Oct 2022–Sep 2024 | better than U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 13.2%CMS range 10.3–17.6 | 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 | 59.0% | 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 | 57.7% | 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 | 43.0% | 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 | 99.5% | 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 | 100.0% | 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 | 96.4% | 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 | 1.0% | 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 | 1.0% | 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 | 9.3%CMS range 6.9–13.0 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 1.16 | 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 108.9 residents a day — about 91% occupied, or roughly 11 beds typically open. It runs fairly full. 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 3.62 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.33 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.15 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 3.52 hrs/resident/day on weekends vs 3.65 on weekdays — 4% thinner on weekends. RN hours go from 0.40 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 42% is about the same as the national median of 45%. 1 administrator has left in the past year.
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.
21 citations, most serious first. The 13 most serious are shown; the remaining 8 are one tap away and print in full.
- Immediate jeopardy · J2026-05-13 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on resident and staff interviews, review of facility and resident records, and a review of the manufacturer's instructions for Resident #1's rolling walker, the facility failed to ensure that Resident #1 received adequate supervision and sufficient safeguards to prevent an avoidable accident. Staff failed to understand the proper use of the resident's rollator which resulted in Resident #1, one of seven residents reviewed for accidents, falling backwards and striking his head on the cement sidewalk. This failure resulted in a traumatic subarachnoid hemorrhage requiring three days of monitoring in the Intensive Care Unit (ICU) at an acute care hospital.On 04/06/2026 at approximately 10:35 AM while on a group nature walk/resident outing, Resident #1 was walking on the sidewalk using his four-wheeled walker (FWW)/rollator with oversight/assistance from the Social Services Director (SSD). Resident #1 became tired and sat down on the seat of his walker. The SSD began pushing him down the sidewalk toward 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.
- Immediate jeopardy · J2024-06-07 · tag F0578 — failed to honor advance directives / code status — isolatedHonor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on a review of resident records, facility reports, staff interviews, and the facility's policies and procedures titled Advance Directives and Florida Cardiopulmonary Resuscitation (CPR), the facility failed to act in accordance with the resident's Advance Directives and his Full Code status (the desire to be resuscitated in the event of cardiac/respiratory arrest) after finding him unresponsive with no respirations. This affected one (Resident #1) of three residents reviewed for Advance Directives. The facility's failure to honor Resident #1's Advance Directives deprived him of potentially lifesaving measures. Resident #1 was not revived and expired in the facility. Immediate Jeopardy (IJ) at a scope of J (isolated) was identified at 1:34 p.m. on [DATE]. On [DATE], at 7:35 a.m., Immediate Jeopardy began. On [DATE], at 5:30 p.m., the Interim Administrator/Associate Regional [NAME] President of Operations (ARVPO) was notified of the IJ determination, IJ templates were provided, and Immediate Jeopardy was…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Immediate jeopardy · J2024-06-07 · tag F0678 — failed to provide CPR when needed — isolatedProvide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
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 a review of resident records, facility reports, staff interviews, and the facility's policy and procedure titled Florida Cardiopulmonary Resuscitation (CPR), the facility failed to provide CPR for one resident who was a Full Code status (the desire to be resuscitated in the event of cardiac/respiratory arrest) after finding him unresponsive with no respirations. This affected one (Resident #1) of three residents reviewed for Advance Directives. The facility's failure to provide CPR according to Resident #1's Advance Directives deprived him of potentially lifesaving measures. Resident #1 was not revived and expired in the facility. Immediate Jeopardy (IJ) at a scope of J (isolated) was identified at 1:34 p.m. on [DATE]. On [DATE], at 7:35 a.m., Immediate Jeopardy began. On [DATE], at 5:30 p.m., the Interim Administrator/Associate Regional [NAME] President of Operations (ARVPO) was notified of the IJ determination, IJ templates were provided, and Immediate Jeopardy was removed, effective [DATE]. 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 · Fcited before2025-05-08 · tag F0880 — failed to prevent and control infections — widespreadProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interviews, record review, and a review of the facility's policies and procedures, the facility failed to implement a comprehensive water management program for the purpose of reducing the risk of growth and spread of Legionella and other opportunistic pathogens in the facility's water system for its current census of 103 residents. Residents of nursing homes who may suffer from a weakened immune system, chronic lung disease, or other underlying medical conditions such as immunosuppression, are at risk for Legionnaires' Disease (type of pneumonia) if exposed to Legionella bacteria. Facilities must be able to demonstrate their measures to minimize the risk of Legionella and other opportunistic pathogens in building water systems such as by having a documented water management program that must be based on nationally accepted standards. The program must include an assessment to identify where Legionella and other opportunistic waterborne pathogens could grow and spread; measures to prevent the growth of opportunistic waterborne pathogens (control measures), and how to monitor…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2025-05-08 · tag F0645 — patternPASARR 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 record review, interviews, and a review of facility policies and procedures, the facility failed to ensure that residents with mental disorders were appropriately assessed on admission or as needed to determine the need for specialized services for four (Residents #21, #32, #89, and #42) of five residents reviewed for Preadmission Screening and Resident Review (PASRR). The findings include: 1. A review of the medical record revealed that Resident #21 was admitted to the facility on [DATE] with diagnoses including bipolar disorder and depression. A review of the quarterly minimum data set (MDS) assessment, with an assessment reference date (ARD) of 2/1/25, revealed that active psychiatric disorders were noted as depression and bipolar disorder. A review of the Level I PASRR dated 3/1/22, revealed that Section #1 was not completed to indicate the resident's diagnoses. (Copy obtained) 2. A review of the medical record revealed that Resident #32 was admitted to the facility on [DATE] with diagnoses…
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 · E2024-02-08 · tag F0924 — patternPut firmly secured handrails on each side of hallways.
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, staff interviews, and facility policy and procedure review, the facility failed to equip corridors with firmly secured and intact handrails. The facility staff failed to report/service the handrails outside of resident rooms #205 and #511, handrails next to the clean utility linen closet located on the 200 hallways, and handrails located around the 400 hallways' nursing station. Handrails in these locations were observed with jagged ends and sharp edges, posing a risk of injury to residents, staff and other building occupants. Daily facility rounds are important to ensure handrails are firmly secured and in good condition to prevent resident injury. The findings include: On 02/05/2024 at 1:10 PM, an observation was made of the handrails located outside of rooms #205 and #511, which were missing end caps. (Photographic evidence obtained) An interview was conducted with Certified Nursing Assistant (CNA) J on 02/07/2024 at 1:05 PM. He stated residents usually reported maintenance requests 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.
- Potential for harm · Dcited before2024-02-08 · 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
Based on observations, staff interviews, and a review of the facility's Maintenance policy and procedure, the facility failed to ensure maintenance was provided to maintain a safe, clean, and comfortable environment for two (Rooms #502 and #508) of 70 rooms in the facility. The air conditioners' electrical covers were broken, and parts of the covers were missing and had become detached from the units in these two rooms. The findings include: A facility tour was conducted on 2/6/24 at 11:00 a.m., and two air conditioning units were observed in need of repair in rooms #502 and #508. The electrical covers for the air conditioners were broken with parts of the covers missing and detached from the units. The units were observed daily on 2/7/24 and 2/8/24. (Photographic evidence obtained) A tour and interview were conducted with the Maintenance Director on 2/8/24 at 12:07 p.m. He reported being unaware of the concerns with the two air conditioning units in rooms #502 and #508. He confirmed that the electrical covers were not attached securely, parts were missing and parts of the covers…
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 · D2024-02-08 · tag F0638 — isolatedAssure that each resident’s assessment is updated at least once every 3 months.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record reviews and staff interviews, the facility failed to assess a resident using the quarterly review instrument specified by the State and approved by CMS (Centers for Medicare and Medicaid Services) not less frequently than once every three months for three (Residents #11, #68, and #226) of three residents reviewed, from 34 residents in the total sample. Failure to complete resident minimum data set (MDS) assessments could result in a failure to provide needed care, contributing to residents' inability to maintain their highest practicable physical, mental, and psychosocial well-being. The findings include: A review of the medical record for Resident #11 revealed that the required quarterly assessment, due by 12/10/2023, was not documented as having been completed. A review of the medical record for Resident #68 revealed that the required quarterly assessment, due by 12/7/2023, was not documented as having been completed. A review of the medical record for Resident #226 revealed that the required quarterly assessment, due by 12/10/2023, was not documented as having…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2024-02-08 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, record review, interviews, and a review of the facility's Oxygen Therapy policy and procedure, the facility failed to ensure oxygen was administered at the physician-ordered flow rate for one (Resident #54) of one resident reviewed for oxygen therapy from a total of 34 residents in the sample. The findings include: An observation and interview was conducted with Resident #54 in her room on 2/5/24 at 11:00 a.m. She reported that her oxygen flow rate was set at 2 liters per minute via nasal cannula. The oxygen flow rate was observed to be set at 2.5 liters per minute. A review of the resident's medical record revealed a re-entry to the facility on 1/5/24 with diagnoses that included acute and chronic respiratory failure, emphysema, congestive heart failure and atrial fibrillation. The resident's active physician's orders were reviewed which noted: Respiratory: oxygen at 2 liters via nasal cannula continuous. The care plan was reviewed, which was updated on 1/25/24. Resident has oxygen therapy related to respiratory illness and receives oxygen via nasal prongs at…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2024-02-08 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, resident and staff interviews, medical record review, and a review of facility policies and procedures, the facility failed to maintain and implement its infection control program to prevent the development and transmission of communicable diseases and infections, when three employees (Employees C, E, and F) were observed failing to use personal protective equipment (PPE) in transmission base precaution (TBP)/isolation rooms. Supplies for hand hygiene were not provided in the soiled utility room, PPE was not readily available and convenient to the staff for use in TBP rooms, and employees failed to perform hand hygiene when leaving a TBP room. Failure to follow infection control protocols and procedures could leave vulnerable nursing home residents at risk of contracting infections that could be detrimental to their health. The findings include: On 02/05/2024 at 10:25 AM, Certified Nursing Assistant (CNA) C was observed donning PPE appropriately. He then entered room [ROOM NUMBER] 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.
- Potential for harm · F2022-03-03 · tag F0812 — failed to store, cook, and serve food safely — widespreadProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, interviews, and facility policy review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety, by failing to 1) Ensure wet nesting did not occur, 2) Maintain safe food temperatures, 3) Label and date food items in the [NAME] Wing nourishment room refrigerator/freezer, 4) Dispose of outdated and unlabeled/undated foods items properly, 5) Maintain thermometers in the East and [NAME] Wing nourishment room freezers, 6) Ensure hot water was available in the kitchen handwashing sinks, and 7) Ensure the kitchen trashcan pedal, which opened the trashcan lid, was functional. These failures had the potential to negatively impact all residents who received food from the facility kitchen and nourishment rooms. The findings include: An observation of the kitchen was made on 2/27/2022 at 3:25 p.m. Neither of the two hand washing stations had hot water. The trash can foot pedal was not working at the hand washing station nearest to the kitchen entrance. At 3:45 p.m., a dietary aide was observed…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Ecited before2022-03-03 · tag F0584 — failed to keep a safe, clean, comfortable home — patternHonor 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 during four of four days, record reviews, and interviews, the facility failed to provide a safe, clean, comfortable, and homelike environment for eleven (Residents #14, #65, #57, #100, #30, #1, #7, #27, #32, #45, and #252) of 46 residents in the sample. Specifically, the facility failed to maintain housekeeping and maintenance services in resident rooms and common areas. The findings include: On 2/27/22 at 12:20 p.m., Resident #1's bathroom was observed with a soap dispenser bag lying on the toilet tank. Grab bars were discolored, the floor was soiled, and the air conditioning vent was covered in grey debris. (Photographic evidence obtained) On 2/27/22 at 12:24 p.m., Resident #7's bathroom was observed with a toilet that was soiled above the water line. (Photographic evidence obtained) On 2/27/22 at 12:40 p.m., Resident #100's bathroom was observed with a vent covered in grey, thickened debris. The drain cover under the sink was broken. Grab bars had a rusted appearance, and the sink faucet…
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 · D2022-03-03 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, interviews, and facility policy review, the facility failed to treat one (Resident #1) of 46 sampled residents with respect and dignity in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life, by failing to ensure the resident's urinary drainage bag was covered for privacy. The findings include: On 2/27/22 at 12:20 p.m., Resident #1 was observed awake and lying in bed. A urinary catheter bag was observed on the right side of her bed facing the door. The catheter bag was not covered with a privacy/dignity bag and urine was visible in the bag from the hallway. On 2/27/22 at 2:07 p.m., Resident #1 was observed in her room from the hallway. Her door was open and her urinary catheter bag was hanging from the right side of her bed. It was not covered with a privacy/dignity bag. On 2/28/22 at 9:15 a.m., Resident #1 was observed lying in bed. Her urinary catheter bag was not covered with a privacy/dignity bag. Urine was visible in the bag. On 3/1/22 at 8:22 a.m., Resident #1 was observed lying in bed. Her door was open…
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 8 citations
- Potential for harm · Dcited before2022-03-03 · tag F0645 — isolatedPASARR 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 a review of resident records and interviews with staff, the facility failed to obtain a Level 2 Preadmission Screening and Resident Review (PASARR) in order to determine appropriateness of placement in a nursing facility and to provide the most appropriate setting and support for one (Resident #34) of five residents identified with serious mental disorders requiring a Level 2 screen, from a total of 45 residents in the sample. The findings include: 1. A medical record review for Resident #34 found she was admitted to the facility on [DATE], with a re-entry date of 2/16/22. Her diagnoses included anxiety, paranoid schizophrenia, major depressive disorder and mild intellectual disability. Resident #34 had a Level I PASRR dated 11/18/21. The screening tool indicated under section I.A. Mental Illness (MI) or Suspected MI, that Resident #34 had diagnoses of bipolar and depressive disorders. Section II. question 2.a. was marked Yes, indicating Resident #34 experienced functioning limitations in major life…
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 · D2022-03-03 · tag F0677 — failed to help fully-dependent residents with daily care — isolatedProvide 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 observations and interviews, the facility failed to provide personal grooming for one (Resident #30) of a sample of 46 residents. Resident #30 was dependent on staff for care, and his fingernails were long with a thick black substance underneath, which could have resulted in scratches and a potential infection. The findings include: Resident #30 was observed in his room on 2/28/2022 at 9:15 a.m. He was lying in bed with an indwelling urinary catheter, which was hanging on the bed rail covered by a privacy bag. He pulled his covers down and his fingernails were approximately an inch long with a thick black substance underneath them. The resident was observed in his room lying in bed on 3/1/2022 at 8:58 a.m. His nails are still long and unclean. He acknowledged that they were long and stated he would allow staff to cut them. The resident was observed in his room lying in bed on 3/2/2022 at 9:00 a.m. He reported that no one had cut his fingernails or cleaned them. They were still long and filled with a black substance underneath. A medical record review was conducted, which…
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 · D2022-03-03 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide appropriate treatment and care according to orders, resident’s preferences and goals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review, observation and interviews, the facility failed to ensure provision of care and treatment in accordance with professional standards of practice for one (Resident #256) of 46 residents reviewed, by failing to obtain orders for the care and monitoring of a peripherally inserted central catheter (PICC) line. Resident #256 was admitted from the hospital with a PICC line for antibiotic therapy to treat a urinary tract infection (UTI). The facility was administering intravenous (IV) antibiotics and flushing the PICC line without a physician's order. There was no physician's order for PICC line dressing changes, and no dressing change occurred for 11 days, despite the facility's policy for catheter site dressing regimens. The findings include: A review of Resident #256's medical record revealed he was admitted to the facility from an acute care hospital on 2/18/2022 with an admitting diagnosis of urinary tract infection (UTI). He was receiving antibiotics that required intravenous access. No physician's orders were found in the resident's record for assessment,…
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 · D2022-03-03 · 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
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record review, the facility failed to ensure that residents with limited range of motion received the appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion for one (Resident #89) resident reviewed, out of 14 residents with contractures, from a total of 46 residents in the sample. Specifically, the facility failed to apply and remove Resident #89's left wrist splint as ordered, which could result in the worsening of her contracture. The findings include: An interview was conducted with Resident #89 and her family representative on 2/28/2022 at 1:00 p.m. During the interview, the family representative stated the resident had a splint that she was supposed to wear on her left wrist at night. The family representative stated she came to visit and put the splint on Resident #89 every night around 6:00 p.m., because the staff either did not know how to put it on, or they just did not put it on. A review of Resident #89's medical record…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2022-03-03 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolatedProvide safe and appropriate respiratory care for a resident when needed.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, interviews, and record reviews, the facility failed to ensure that a resident who required respiratory care, was provided such care, consistent with professional standards of practice, for two (Residents #354 and #53) of six residents receiving respiratory treatment, from a total of 46 residents in the sample, by failing to administer oxygen at the flow rate ordered by the physician. The findings include: 1. An interview was conducted with Resident #354 at 11:53 a.m. on 3/2/2022. During the interview, the oxygen concentrator was observed with a flow rate set at 3 liters per minute (LPM). When asked about the flow rate currently set on her concentrator, the resident stated she liked it set at 3 LPM. She used oxygen at 3 LPM at home and she could breathe better. She stated she couldn't breathe with the flow rate set at 2 LPM. When asked if the staff adjusted her oxygen, the resident replied, No, it has always been set at 3 liters. A review of the resident's medical record revealed an admission date of 2/11/2022 and pertinent diagnoses including chronic…
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 · D2022-03-03 · tag F0697 — failed to manage pain — isolatedProvide safe, appropriate pain management 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, interviews, medical record review, and facility policy review, the facility failed to ensure that pain management was provided to residents who required such services, consistent with professional standards of practice and the comprehensive person-centered care plan, for one (Resident #41) sampled from a total sample of 46 residents. The findings include: On 2/27/2022 at 3:40 p.m., Resident #41 was observed lying in bed awake. His right knee was swollen with a lidoderm patch covering it. Resident #41 stated, I used to get pain pills but they took them away. I don't know why, but my knee is very painful. I need a knee replacement eventually, but for now, I don't know why they only use this patch and not any pain pills. Resident #41 was asked if he had explained his pain to the clinical staff and asked for pain medicine. He stated, Yes, I've asked and they say I don't have any (pills). They never ask me about my pain, no one questions me about my pain. Resident #41 was asked to rate his pain…
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 · D2022-03-03 · 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 observation, interviews, medical record review, and facility policy review, the facility failed to store all drugs and biologicals in locked compartments for two (Residents #39 and #94) residents reviewed from a total sample of 46 residents. A facility is required to secure all medications in a locked storage area and to limit access to authorized personnel consistent with state and federal requirements and professional standards of practice. The findings include: On 2/27/2022 at 3:40 p.m., Resident #39 was observed in her room, sitting up in her wheelchair. A bottle of Artificial Tears (expiration date 10/2022) and a bottle of Clear Eyes eye drops (expiration date 1/2024) were observed on her bedside table. She was asked if they were her eyedrops. She stated, Yes, they are mine. I use them in the morning. On 2/27/2022 at 3:55 p.m., Resident#94 was observed lying in his bed. A bottle of Systane eye drops (expiration date 2/2022) was observed on top of his bedside table. The resident was unable to articulate if he was aware that the eye drops were on his bedside table, or…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2022-03-03 · tag F0814 — failed to dispose of garbage properly — isolatedDispose of garbage and refuse properly.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observations, interviews and facility policy review, the facility failed to dispose of garbage and refuse properly. The findings include: An observation of the dumpster was made on 3/2/2022 at 3:30 p.m. The dumpster was behind a locked gate. It was observed with strips of cloth plugging the corner where a dumpster drain plug should be. The cloth strips were soiled and covered with insects. (Photographic evidence obtained) Outside of the dumpster, there were several pieces of trash, including a plastic cup, a chip bag, a large, clear plastic bag, an old tray cart, and plastic shelving. (Photographic evidence obtained) The Certified Dietary Manager (CDM) was interviewed at the time of the observation and reported that she had swept last Friday. She was asked why there was a cloth plug in the dumpster and she stated she did not know. She further stated she did not know why it was the dietary department's responsibility to maintain the dumpster area. She addressed a maintenance staff member about the condition of the dumpster/dumpster area during the walk back to the facility'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.
“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
$15,646 in federal fines across 2 penalties.
- $7,823 — penalty dated 2024-06-07
- $7,823 — penalty dated 2024-06-07
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 AVIATA HEALTH GROUP — 50 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 | 2 of 5 | 2.4 | -0.4 vs chain |
| Health inspection | 1 of 5 | 2.0 | -1.0 vs chain |
| Staffing | 2 of 5 | 2.7 | -0.7 vs chain |
| Quality measures | 5 of 5 | 4.1 | +0.9 vs chain |
The other 49 homes this chain runs (chain average 2.4★, per CMS)
Showing 40 of 49; lowest-rated first.
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 | Since |
|---|---|---|---|
| PALM COAST PARENT LLC | Organization | DIRECT OWNERSHIP INTEREST | since 11/02/2023 |
| FLAGLER OAKS HOLDCO LLC | Organization | INDIRECT OWNERSHIP INTEREST | since 11/02/2023 |
| FREUND, NOCHUM | Individual | CORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROL | since 11/02/2023 |
| KINNE, SANDFORD | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 08/12/2024 |
| MCKINNEY, KIMBERLY | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | since 07/15/2024 |
| DAGAN, AMITAI | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/10/2025 |
| GOLDBERGER, ABRAHAM | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/10/2025 |
| GOLDBERGER, FAIGY | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/10/2025 |
| HERSKOWITZ, ELIEZER | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/10/2025 |
| HERSKOWITZ, YAAKOV | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/10/2025 |
| TRAVITSKY, AARON | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | since 07/10/2025 |
| ASPIRE MGT LLC | Organization | ADP OF THE SNF | since 11/02/2023 |
CMS files one row per role, so the 15 rows in the source record cover these 12 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.
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 $191K paid to related parties (affiliated landlords or management companies) in its most recent cost report. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.
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 105952. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-05-08, 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.