Shores Nursing And Rehab Center

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

46.1% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 52 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 66.7% 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 36 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 0.22 therapist hours per resident per day in 2026Q1 — more than 27% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 18% 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 98.8 residents a day — about 82% occupied, or roughly 21 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.34 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.49 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.11 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 3.31 hrs/resident/day on weekends vs 3.34 on weekdays — 1% thinner on weekends. RN hours go from 0.52 to 0.40 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 53% is about the same as the national median of 45%. 2 administrators have left in the past year — frequent leadership churn is a warning sign families often miss.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

40 citations, most serious first. The 17 most serious are shown; the remaining 23 are one tap away and print in full.

• Immediate jeopardy · L2024-02-02 · tag F0835 — failed to run the facility competently — widespread
  Administer the facility in a manner that enables it to use its resources effectively and efficiently.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation of laundry storage and laundry procedures, staff interviews, review of the laundry policy, review of laundry training, and review of job descriptions, the facility Administration failed to provide oversight in a manner that enabled the facility to use its resources effectively and efficiently to attain or maintain the highest practicable level of well-being for all 68 residents in the facility. Administrative staff failed to ensure that essential equipment, washing machines, were in working order and facility textiles and resident clothes were stored, sorted, processed and transported in a manner to prevent cross-contamination in accordance with facility policy. The facility failed to ensure that the facility Infection Preventionist had oversight of the laundry procedures. The facility failed to update their laundry procedures to ensure hygienic laundry after both facility washing machines failed, and the facility made the determination to utilize a local laundromat. The facility had 2 commercial grade washing machines, one broke in December 2022 and the second…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Administration Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · L2024-02-02 · tag F0867 — failed to act on quality-improvement findings — widespread
  Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, staff interviews, resident interviews, and quality assurance performance improvement plan (QAPI) review, the facility failed to develop and implement appropriate plans of action to correct identified quality deficiencies related to ensuring an adequate supply of clean linens was readily available for resident use and care; ongoing housekeeping and maintenance issues throughout the facility; maintaining essential equipment (washing machines) in good operating order; and infection control processes and training related to laundry processing. Concerns were previously identified with clean linen availability, broken laundry equipment and the QAPI processes during a complaint investigation ending a year ago on 2/02/2023 [refer to the Statement of Deficiencies, Form CMS-2567, Survey Event ID # 8Q7X11. Citations were issued at F584 (Environment) and F867 (QAPI). The facility had 2 commercial grade washing machines, one broke in December 2022 and the second broke on or before November 2023 (exact dates could not be determined). Soiled laundry (linens, towels, resident…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Administration Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · L2024-02-02 · tag F0880 — failed to prevent and control infections — widespread
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation of laundry storage and laundry procedures, staff interviews, review of facility laundry policy, facility laundry inservices, and a review of the Centers for Disease Control (CDC) guidelines, the facility failed to ensure that facility textiles and resident clothes were stored, sorted, processed and transported in a manner to prevent cross-contamination in accordance with facility policy and recommendations by the CDC. The facility failed to ensure that the facility's Infection Preventionist had oversight of the laundry procedures. The facility failed to update their laundry procedures to ensure hygienic laundry after both facility washing machines failed, and the facility made the determination to utilize a local laundromat. This failure had the potential to affect all 68 residents at the time of the survey. Additionally, the facility failed to ensure appropriate infection control practices were followed for 1 of 1 fingerstick blood glucose checks observed (Resident #10). The facility had 2 commercial grade washing machines, one which became non-functional in…

  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.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · L2024-02-02 · tag F0908 — failed to keep essential equipment working — widespread
  Keep all essential equipment working safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, resident interviews, staff interviews, ombudsman interview, and review of facility provided documentation, the facility failed to maintain 2 of 2 laundry washing machines in good repair. Both of the facility washing machines have been non-functional since at least November 2023 (exact date could not be determined). The first washing machine became non-functional in the month of December 2022 (exact date could not be determined) and remained broken. Staff were unable to demonstrate the specific date the second washing machine broke. Invoices indicated that parts were ordered both in September 2023 and November 2023. Observations found a lack of readily available linens in 2 of 2 linen closets, resident beds with missing sheets and pillowcases, residents observed without a change of clothing in their closets, and residents wearing hospital gowns. This failure had the potential to affect all 68 residents residing in the facility at the time of the survey. Due to the lack of washing machines, facility staff were transporting soiled laundry to a local laundromat…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Environmental Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · L2024-02-02 · tag F0945 — failed to train staff on abuse prevention — widespread
  Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation of laundry storage and laundry procedures, staff interviews, review of facility laundry policy, and facility laundry staff training, the facility failed to ensure that staff were trained in infection control processes related to the laundering of linens and resident clothing to prevent cross-contamination. Both of the facility laundry machines (2 of 2) have been non-functional since at least November 2023. Facility staff are transporting soiled laundry to a local laundromat for washing, then bringing the wet laundry back to dry. However, not all the wet laundry could be dried at once, so some of the clean wet laundry was stored wet, often overnight. The laundry was not being handled, stored, processed, or transported, in a manner to prevent the spread of infection. On 2/1/2024, clean wet linens were observed in clear plastic bags that were stored inside bins labeled Soiled Linen and clean wet linens were observed outside stacked on a wooden pallet. Dirty linens were observed on the floor in both a shower room, and piled on the floor on the dirty side of 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.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2024-02-02 · 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

  Based on observations, resident interviews, staff interviews, and clinical record review, the facility failed to implement the care plan for 2 of 2 sampled residents with Activity of Daily Living Care concerns (Resident #9 and #45). The facility identified that resident #9 needed extensive assistance with transfers, ambulation, dressing, toileting, and bathing. The facility failed to provide bathing in accordance with the resident's abilities and preferences. The facility failed to assist with ambulation (walking) and transfers out of bed since November 2023 for Resident #9. The resident was observed dressed in a hospital style gown. The facility failed to provide timely incontinence care for 12 hours the evening/night of 1/31/24 into the morning of 2/1/24. The morning of 2/1/24, during incontinence care, a new buttocks wound was discovered for Resident #9. The facility failed to provide wound care for 7 days in accordance with the care plan for resident #45. The skin around the wound was missing and yellow exudate and redness were present. The findings include: Resident #9 A review…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Actual harm · G2024-02-02 · tag F0676 — failed to keep up residents' daily-living abilities — isolated
  Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, resident interviews, staff interviews and clinical record review, and the facility failed to provide necessary care and services to ensure that a resident maintains or improves abilities in activities of daily living (ADL) for 1 of 2 residents sampled for ADL care, #9. The facility failed to provide bathing and dressing assistance in accordance with the resident's abilities and preferences. The facility failed to assist with mobility (walking) and transfers out of bed since November 2023. During the survey, when the facility did assist resident #9 out of bed on 1/31/24, Resident #9 was left in a wheelchair for about 10 hours. The facility failed to provide timely incontinence care for 12 hours the evening/night of 1/31/24 and morning of 2/1/24. This failiure resulted in the discovery of a new buttocks wound on 2/1/24. The findings include: Resident #9 On 1/29/24 at approximately 11:50 AM, Resident #9 was observed asleep in the bed. The bed was raised all the way up to the highest position. Resident #9 was on a pressure reducing mattress with no sheet and a…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2026-05-04 · tag F0584 — failed to keep a safe, clean, comfortable home — pattern
  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and policy review, the facility failed to provide an environment that is free of offensive odors and failed to maintain a sanitary and clean environment in 7 of 15 rooms on the 300 unit and 8 of15 rooms on the 400 unit. (Rooms identified are 341, 342, 348, 352, 353, 354, 355, 456,461,464, 466, 467, 468, 469, 470, including the patio outside the 400 unit.)The findings include:On 4/29/26 upon entrance to the facility, a strong, pungent urine-like smell was noted. The smell of urine was present throughout the facility but noted to be stronger on the 200, 300, and 400 halls. On 4/29/26 at 10:30 AM, upon entry into the facility and while observing the clinical nursing units, a strong odor of urine was noted. At 10:40 AM an observational tour was conducted on unit 300 and 400 nursing units, where a strong odor of urine was noted. The 300-unit hallway observation revealed torn flooring, food particles, and a butter knife laying in the floor in the hallway. room [ROOM NUMBER] had a straw…

  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 · D2026-05-04 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based upon interviews and record reviews, the facility failed to notify state and federal agencies of an incident involving elopement of a resident from the facility for 1 of 2 residents reviewed for elopement. (Resident #5)The findings include:During review of facility incidents, it was documented that on 2/28/26 at approximately 12:15 PM, Resident #5 exited the facility building from his bedroom window and walked across the facility property toward the perimeter fence. It was documented that a CNA saw Resident #5 and called out for assistance. It was documented that staff were able to redirect Resident #5 and escort him back to the facility where he was placed on one-to-one supervision for safety. It was documented that facility maintenance conducted an inspection on all window seals in Resident #5's room to ensure proper securement was in place. It was noted that this investigation did not include any staff or witness statements for review.An interview was conducted with Resident #5 on 5/1/26 at 10:30 AM concerning his leaving the facility on 02/28/26. Resident #5 remembered the…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-05-04 · 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 observation, interviews, and record review, the facility failed to provide the necessary care and services to maintain grooming and incontinence care for 1 of 2 residents sampled for incontinence care (Resident #7).The findings included:On 4/29/26 at 3:45 PM, Resident #7 was observed standing in the doorway of his room holding onto a wheelchair. Resident #7's navy-colored pants were observed to be wet, covering the seat of his pants extending down both legs to the calves. Resident #7 had a strong odor of urine and stated, I have been waiting on them to change my clothes. A follow up observation was made on 4/29/26 at 5:18 PM. Resident #7 was observed to be wearing the same soiled navy-colored pants and red shirt, seated in a wheelchair next to the nurses' station.An observation was conducted of Resident #7 on 4/30/26 at 1:20 PM. Resident #7 was observed wearing the same soiled clothes as the previous day. Resident #7 smelled of urine, and his shirt was soiled with food and a dark liquid. Upon interview, Resident #7 stated that he wanted fresh clothes and that he had asked…

  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 · Dcited before2025-12-08 · 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 and interviews, the facility failed to ensure residents in the 400 Hall Memory Care Unit lived in a clean, comfortable, homelike environment. The findings include:On December 8, 2025 at 1:40 pm, a tour of the facility's Memory Care unit (400 Hall) revealed the floors throughout the unit had food/debris. The floors were sticky in the Dining area and throughout the all the resident rooms. room [ROOM NUMBER]'s floor was full of debris and food. room [ROOM NUMBER] had a mattress on the floor with fall mats. The floors were extremely dirty, the mats were dirty, and the sheets on the bed were stained. (photographic evidence obtained)At this time, Staff A, Personal Care Assistant (PCA), was observed using a mop at the end of the hallway. When asked about housekeeping, he stated he is normally a PCA but all of maintenance and housekeeping called out sick today, so he was fulfilling those duties. At 2:00 pm, an interview with the Director of Nursing revealed several staff in housekeeping called out…

  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 · D2025-05-08 · 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 resident council interviews, review of resident council grievances, staff interviews, and policy reviews, the facility failed to demonstrate acting upon 1 of 1 sampled grievances filed by the resident council regarding food. The findings include: A meeting was held with the Resident Council members in the facility on 5/7/25 at 2:20 PM, which included Residents 2, 17, 30, 32, and 55. During the meeting, the residents voiced ongoing concerns about the variety and quality of the food served by the facility. The residents stated the food was sub-par and the menu changed based on what the kitchen has available. The only alternate meal items that are available were a grilled cheese sandwich, egg salad sandwich, tuna sandwich, or peanut butter and jelly sandwich. They have voiced several complaints about the food and do not always receive the monthly resident choice meal either. They can no longer have fried chicken because the facility cannot purchase oil to fry the chicken, and they bake the chicken instead. They stated that families bring in food from outside to the residents.…

  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 before2025-05-08 · 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 observation, resident interviews, and staff interviews, the facility failed to maintain resident equipment in a safe and sanitary manner in 1 of 20 rooms. (room [ROOM NUMBER]) The findings include: On 05/05/25 at approximately 12:00 pm, upon observation of room [ROOM NUMBER], it was noted that the base boards visible from the entrance of the room were damaged, cracked, and held together with blue painter's tape and that the bed frame of one of the residents in this room had extensive rust covering more than half the length of the bed. On 05/06/25 at approximately 12:50pm, an interview was performed with Maintenance Employee A and the Administrator about maintenance issue tracking. Employee A stated that he rounds daily to make sure exit doors are working properly, inspects the hallways for anything obvious that might need fixing, and checking the maintenance log that is located at each nurse's station. When asked about the rusted bed frame and baseboards from room [ROOM NUMBER], Employee A stated that…

  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 before2025-05-08 · 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

  Based upon observations, record reviews, and interviews, the facility failed to provide a comprehensive person-centered care plan process to meet the needs and services for six out of twenty-one residents reviewed. (Residents #5, #10, #27, #79, #31, and #51) The findings include: Resident #5 A record review on 5/6/25 of Resident #5 revealed diagnoses of Chronic obstructive pulmonary disease (COPD), Dementia, Schizophrenia, Cerebrovascular accident (CVA), Type 2 Diabetes, Epilepsy, and Heart Failure. A plan of care was initiated on 8/26/24 for review of functional abilities with goal to maintain current level of functioning abilities but no interventions were in place. Resident #5 had no plan of care in place prior to 5/7/25 for limited range of motion. This plan of care was initiated post interview with the Director of Nursing (DON) on 5/6/25. The DON stated that the facility only had a partial restorative program in place for dining activities only. Resident #10 A record review on 05/06/25 for Resident #10 revealed diagnoses of Chronic respiratory failure, Arteriosclerotic Heart…

  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 before2025-05-08 · 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 upon observations, interviews and record reviews, the facility failed to meet the needs and services of resident number 27 who is unable to carry out activities of daily living. The findings include: An observations was conducted on 05/05/27 at 12:30 PM revealed resident 27 lying in bed with her head resting against the side rail, hair appears tangled, unkept, and messy with her bangs hanging over into her eyes. Resident 27 teeth appear to have yellowish colored substance build up around teeth and gums when she smiled, shirt unclean with notable stains on the front of the shirt. On 5/6/27 at 08:40 AM resident 27 is observed laying in bed with a yellow and white striped shirt on, pulled up to her upper torso just below her breast area, incontinent brief on, with a white thin sheet covering her lower extremities. Her teeth is observed with a thick yellowish substance around her teeth and gum line. Her hair is messy and unkept. An observation was made on 5/6/27 at 12:21 PM of resident 27 coming out of dining room with assistance from staff noted to be in a pair of black pull up…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-05-08 · tag F0688 — failed to keep residents mobile / prevent decline — isolated
  Provide 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 upon observations, interviews and record review, the facility failed to provide care and services for 1 of 1 residents reviewed for range of motion (Resident #5). The findings include: An observation of Resident #5 was made on 5/6/25 at 08:30 AM. The resident was lying in bed awake and alert, with the head of the bed (HOB) elevated at an approximately 90-degree angle. The bedside table was placed in front of Resident #5 across her lap area with her breakfast tray sitting on top. Resident #5 reached for her cup with her left hand. Her left hand had a contracture with the third, fourth, and fifth digits resting on her left inner palm. No splints or devices were observed on her left hand. At 12:00 PM, Resident #5 was observed sitting up in her bed with the HOB elevated at a 90-degree angle. Her lunch tray was sitting on top of the bedside table. Again she was observed without splints or devices to the left hand. Further observations on 5/6/25 at 2:00 PM and 4:30 PM; on 5/7/25 at 8:30 AM, 11:30 AM, 1:00 PM,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-05-08 · tag F0698 — failed to provide proper dialysis care — isolated
  Provide safe, appropriate dialysis care/services for a resident who requires such services.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on resident interview, record review, and staff interview, the facility failed to provide appropriate care and services of an arteriovenous (AV) fistula for 1 of 1 sampled residents receiving dialysis services. (Resident #39) The findings include: An interview was conducted with Resident #39 on 5/6/25 at 9:15 AM. She stated she had a new fistula in her left arm and the nursing staff did not touch, palpate, or assess the fistula. A review of the resident's medical record revealed the new AV fistula was placed on 4/10/25. The record revealed no physician's orders to check the bruit and thrill of the fistula until an order was placed on 5/7/25. (A thrill is a vibration felt when touching the fistula, and a bruit is a swishing or whooshing sound that can be heard with a stethoscope over the fistula. Both are indicators of normal blood flow through the fistula and are essential for its proper function.) A review of the hospital discharge instructions dated 4/10/25 revealed on page 7 that the fistula site should be checked daily to make sure the thrill feels the same. The 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.

  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

$137,446 in federal fines across 1 penalty.

• $137,446 — penalty dated 2024-02-02

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to ELIYAHU MIRLIS — 13 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

CMS files one row per role, so the 8 rows in the source record cover these 5 parties — each is shown once here with every role it holds. Nothing is omitted.

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

What families pay in FL