Harmony House Health Care 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.

Therapy staffing: this home’s payroll records show 0.20 therapist hours per resident per day in 2026Q1 — more than 22% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 9% 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 65 beds and averages 43.0 residents a day — about 66% occupied, or roughly 22 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. 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 3.84 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.57 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.73 is at or above 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 3.58 hrs/resident/day on weekends vs 3.95 on weekdays — 9% thinner on weekends. RN hours go from 0.67 to 0.32 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 62% is well above the national median of 45%.

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

Inspection trend

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

Inspection deficiencies

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

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

38 citations, most serious first. The 14 most serious are shown; the remaining 24 are one tap away and print in full.

• Immediate jeopardy · J2025-08-06 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, resident, and staff interviews, the facility failed to report an allegation of abuse to the Administrator, as well as the State Survey Agency within the mandated timeframe (2 hours). This resulted in a failure to protect a resident from further harm. Resident #51 reported he told staff about a staff member who grabbed his arms, hurt him, and resulted in multiple dark purple bruises to forearms. The facility's failure to report an allegation of abuse prevented an investigation into the incident, as a result, the harm continued to occur. This failure resulted in Immediate Jeopardy to the health, safety and security of the resident.The State Agency informed the facility of the Immediate Jeopardy (IJ) on 8/5/25 at 4:15 PM. The facility staff removed the Immediate Jeopardy on 8/6/25 through the following actions:The facility completed staff education on 8/5/25 regarding the reporting of allegations and suspicions of abuse, and injury of unknown source. The facility would use the…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Jcited before2025-08-06 · tag F0610 — failed to investigate and act on abuse reports — isolated
  Respond appropriately to all alleged violations.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, resident, and staff interviews, the facility failed to conduct a thorough investigation of an allegation of abuse, resulting in failure to protect a resident from further harm. Resident #51 reported he told staff about a staff member who grabbed his arms, hurt him, and resulted in multiple dark purple bruises to forearms. The facility's failure to investigate the allegation of abuse resulted in further harm to occur. This failure resulted in Immediate Jeopardy to the health, safety and security of the resident.The State Agency informed the facility of the Immediate Jeopardy (IJ) on 8/5/25 at 4:15 PM. The facility staff removed the Immediate Jeopardy on 8/6/25 through the following actions:The facility completed education on 8/5/25 with the Abuse Coordinator regarding reporting allegations and suspicions of abuse as above. The staff would receive education to separate an alleged staff perpetrator immediately per the Abuse policy and guidelines. The facility would commence…

  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
• Actual harm · G2026-03-25 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
  Provide enough food/fluids to maintain a resident's health.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based staff interview, clinical record review, and facility policy review, the facility failed to maintain a resident's nutritional status for 1 of 5 residents reviewed (Resident #4). As evidenced by a significant, unexplained weight loss from 130 pounds on 1/05/26 to 119.5 pounds on 3/25/26. The facility failed to consistently follow the Care Plan intervention to notify the physician and dietitian of significant weight change. Furthermore, the facility did not follow its own policy for Notification for Change in Condition by failing to consult with the resident's physician and notify the Dietitian of a significant change in status (weight loss) and the significant alteration of treatment (reduction of enteral feedings from five times to two times per day) without a documented physician's order or indication. The Registered Dietitian denied receiving report of the resident's frequent refusal of tube feedings throughout February 2026 and the subsequent decrease in feedings, indicating a breakdown in communication and a failure to implement necessary nutritional interventions in 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
• Actual harm · Gcited before2024-01-24 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review the facility failed to ensure communication devices were utilized for 2 out of 3 residents reviewed (Resident #1 and Resident #2). Resident #1 had a communication device that used a button he controlled with his head to select words and phrases on a computer. The communication device could be used when it was not on his wheelchair(w/c). The nursing staff were not educated on how to use the communication device nor did they know they could use the communication device, therefore Resident #1 was communicating with the staff by answering yes or no questions only, limiting his ability to communicate his wants and needs to his full potential. Resident #2 had a picture board with pictures of items that she would/could frequently request. Staff interviewed did not know about a picture board for Resident #2 and stated they had not used the picture board with Resident #2. The picture board could not be found in this resident's room. The facility reported a census of 40…

  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 · E2026-06-30 · tag F0688 — failed to keep residents mobile / prevent decline — pattern
  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 on record review and interview, the facility failed to ensure residents with contractures (shortened muscles) received necessary restorative nursing care to maintain or improve functional potential. Specifically, management canceled passive range of motion (PROM), active range of motion (AROM), and walking programs for Resident #2, Resident #6, Resident #7, Resident #8, and Resident #10 without documenting a clinical rationale in the progress notes. The facility lacked trained or dedicated staff to deliver restorative care interventions. The facility reported a census of 51 residents.Findings include:Review of an undated list titled Contractures identified eight residents currently living in the facility with contractures (shortened muscles). The list included Resident #2, Resident #5, Resident #6, Resident #7, Resident #8, and Resident #10. 1. Resident #2's Minimum Data Set (MDS) assessment dated [DATE] listed Resident #2 sometimes understood others and sometimes could make others understand them. The MDS…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has no plan of correction
• Potential for harm · E2026-06-30 · tag F0695 — failed to provide proper breathing / tracheostomy care — pattern
  Provide safe and appropriate respiratory care for a resident when needed.
  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, policy review, the facility failed to ensure specialized respiratory care was safely provided by qualified personnel for 4 of 4 residents on mechanical ventilation (a life-support treatment that uses a machine to move air in and out of your lungs when you cannot breathe adequately on your own). The facility utilized floor staff to work in the respiratory therapy department and allowed a Licensed Practical Nurse (LPN) to function as the sole licensed nurse onsite without a Registered Nurse (RN) or Respiratory Therapist (RT) present in the building (Resident #1, #5, #6, and #11). The facility reported a census of 51 residents. Findings include:The facility provided an undated document titled Residents with Vents (Ventilators) that revealed four residents at the facility required mechanical ventilation (life-support breathing treatment). The list included Resident #1, Resident #5, Resident #6, and Resident #11. Review of the facility's May June Respiratory and Nursing schedule…

  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 no plan of correction
• Potential for harm · D2026-06-30 · tag F0561 — failed to honor residents' choices — isolated
  Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
  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 policy review the facility failed to ensure 1 of 3 resident received necessary care and services in accordance with professional standards of practice, her comprehensive assessment, and her plan of care (Resident #1). Specifically, staff failed to administer ordered respiratory treatments by omitting or allowing the refusal of tracheostomy (breathing tube) cares on six occasions in May 2026, and failed to provide ordered nutrition by failing to administer her full tube feeding regimen on 13 separate days in May 2026. The facility reported a census of 51 residents. Findings include:Resident #1's Minimum Data Set (MDS) assessment dated [DATE] documented that Resident #1 entered the facility on 1/4/26. The MDS assessment documented a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. Resident #1 depended on staff for toileting and bathing, didn't get out of bed, and required supervision and physical assistance with rolling in bed. Resident #1…

  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 no plan of correction
• Potential for harm · Dcited before2026-06-30 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on clinical record review, family, and staff interviews, the facility failed to provide consistent showers to 1 of 3 residents reviewed (Resident #2). The facility reported a census of 51 residents. Findings include:Resident #2's Minimum Data Set (MDS) assessment dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 99, indicating Resident #2 couldn't complete the interview. Staff noted Resident #2 experienced severe impairment with decisions regarding tasks of daily life and had short-term and long-term memory problems. The MDS assessment revealed Resident #2 had upper extremity (arm) and lower extremity (leg) impairment to both sides and used a wheelchair. The MDS assessment revealed Resident #2 depended on staff for toileting, dressing, bathing, transfers, and rolling in bed, and didn't walk or stand. Resident #2 had diagnoses of traumatic brain injury (TBI; brain damage from an external force), anxiety, depression, contracture (permanent muscle tightening), and dysphagia…

  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 no plan of correction
• Potential for harm · Dcited before2026-06-30 · tag F0725 — failed to have enough nursing staff — isolated
  Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview, record review, and policy review, the facility failed to provide sufficient nursing staff to respond to call lights in a timely manner for 1 of 3 residents reviewed (Resident #1). The facility reported a census of 51 residents. Findings include: Review of the Employee Warning Notice for Staff R, Certified Nursing Assistant (CNA), dated 5/8/26 revealed that on 6/6/26 the facility failed to answer Resident #1's call light within 15 minutes, with one instance lasting 54 minutes and another lasting 16 minutes. The form revealed the incident violated policy and procedure. Review of the Employee Warning Notice for Staff S, CNA, dated 6/16/26 revealed that on 6/12/26 Resident #1's call light remained on for 30 minutes. The form revealed the delay violated policy and procedure. On 6/22/26 at 11:48 AM Resident #1 stated that staff responded to call lights poorly at all times of the day, and responses took up to an hour. On 6/22/26 at 1:20 PM Resident #1 Representative, Power of Attorney (POA), stated that when they first arrived at the facility, call lights took two 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.

  Nursing and Physician Services Deficiencies · Deficient, Provider has no plan of correction
• Potential for harm · D2026-05-18 · tag F0804 — failed to serve food at safe, palatable temperature — isolated
  Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, interviews, and policy review the facility failed to ensure cold food items were maintained at or below 40 degrees Fahrenheit (4 degrees Celsius) and served immediately to prevent potential bacterial growth. Specifically, a half-gallon of milk sat out at room temperature without an ice bath for at least eight minutes, reaching a temperature of 53 degrees Fahrenheit before Staff B, Certified Nurse's Aide (CNA), poured and served a glass of it to a resident. Additionally, the facility left breakfast trays exposed to the open air on a dining room half wall before serving to a resident. One resident, Resident #13 who received one of the meals reported the breakfast was cold as usual. The facility reported a census of 50 residents.Findings include:On 5/12/26 from 8:40 AM to 9:00 AM, Staff A, Cook, dished up four plates for room trays and sat them on the half wall in the dining room in front of the steam table. The trays consisted of foam plates, and Staff A used another foam plate to cover them, which left the sides of the food exposed to open air. Next to 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.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-05-18 · tag F0812 — failed to store, cook, and serve food safely — isolated
  Procure 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, staff interviews and policy review the facility failed to maintain a sanitary kitchen; failed to serve and prepare food in accordance with professional standards for food safety to reduce the risk of cross contamination and food borne illness. The facility reported a census of 50 residents. Findings include:On 5/12/26 from 8:34 AM to 9:00 AM, a continuous observation revealed Staff A, Cook, licked the thumb of her hand at 8:34 AM and proceeded to serve food without performing hand hygiene. Staff A picked up bacon with her hands and placed it on a plate when serving residents. At 8:38 AM, Staff A touched her food-soiled apron with her hands, picked up bacon with her hands, and didn't use the tongs on the steam table.On 5/12/26 at 9:05 AM, a walkthrough of the kitchen revealed the floor in the dry storage area had dried leaves, dried liquid, and food particles on it. A box of soups sat on the floor. In the refrigerator, a liquid eggs box and a sliced ham box of food were stored on the floor. In the kitchen, the flour and sugar bins were covered in flour and food…

  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.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-05-18 · tag F0880 — failed to prevent and control infections — isolated
  Provide 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 observation, record review, staff interviews, the facility failed to implement standard infection control practices and Enhanced Barrier Precautions (EBP) (involves the use of gowns and gloves during high-contact resident care activities for residents known to be colonized, infected and at increased risk of Multidrug Resistant Organisms (MDRO) (bacteria that are resistant to three or more families of antibiotics) for 3 of 3 residents (Resident #15, Resident #24 and Resident #4). The facility also failed to review their infection policy yearly. The facility reported a census of 50 residents. Findings include:1. Resident #15's Minimum Data Set (MDS) assessment dated [DATE] documented he had severe cognitive impairment. The MDS included diagnoses of chronic respiratory failure (long-term inability of the lungs to clear carbon dioxide and provide oxygen) and a resistance to unspecified antibiotics. The MDS documented he's dependent, meaning a helper does all of the effort, the resident does none 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
• Potential for harm · Ecited before2026-03-25 · tag F0725 — failed to have enough nursing staff — pattern
  Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on resident and staff interviews, clinical record review, facility Grievance Log review, call light log review and facility policy review, the facility failed to answer call lights in a timely manner to meet resident needs for 3 of 3 residents (Resident #4, #9, and #11) reviewed for call lights. The facility failed to answer residents' calls for assistance in a timely manner, with logged wait times for multiple residents frequently exceeding acceptable limits (greater than 15 minutes), sometimes lasting over an hour and a half. The failure persisted despite residents reporting concerns through interviews and the facility's own grievance logs and after staff were reportedly re-educated on the importance of responding to call lights and carrying communication devices. Furthermore, staff, including the Director of Nursing, failed to respond to a prolonged audible alarm indicating an issue with a resident's essential feeding tube pump, and the facility did not have a written policy to ensure timely call light…

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

  Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-03-25 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident and staff interview, clinical record review, and facility policy review, the facility failed to communicate to Residents #3, #4, and #12 in a dignified manner and ensure communication between staff, within hearing distance of Resident #3, was conducted in a dignified manner for 3 of 4 residents (R#3, R#4, and R#12) reviewed for resident rights. The facility reported a census of 42 residents. Findings include: 1. Resident #3's Minimum Data Set (MDS) assessment, dated 2/27/26, identified a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. The MDS included diagnoses of paraplegia (impairment of motor and sensory function in lower body), seizure disorder, respiratory failure, and malnutrition. The Care Plan Focus, dated 3/3/26, indicated Resident #3 had a psychosocial well-being complication and a mood state disturbance related to diagnoses of major depressive disorder (MDD), antisocial personality disorder, and post traumatic stress disorder (PTSD).…

  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

“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

$48,825 in federal fines across 1 penalty.

• $48,825 — penalty dated 2026-03-25

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 LEGACY HEALTHCARE — 89 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 41 rows in the source record cover these 39 parties — each is shown once here with every role it holds. Nothing is omitted.

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

Follow the money — this home’s finances

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

About 96% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $1.3M paid to related parties — landlords or management companies under common ownership — equal to about 12% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. 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.

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